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Official Website

of the Commonwealth of Pennsylvania

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    Applications and Forms

    Forms (All)

    Approved CPR Providers for Authorization to Administer Injectables (PDF)

    Change of Name and/or Address

    Intern Experience Reporting (PDF) - Please scan your form and attach it to a ticket that you create.  Log in to your PALS account at www.pals.pa.gov and click on the comment bubble located to the right of your pharmacy intern registration number under the "Professional License Details" banner.  You may also create a ticket by clicking on the "Support" link on the top blue banner at www.pals.pa.gov.  The Board office staff will respond to your ticket.  Do NOT mail the form/submit a postcard.

    Request Verification of Intern Hours (PDF)

    Verification of licensure to another state - request ONLINE

    NOTE:  As a result of document fraud and in an effort to protect its licensees, the Board will only provide direct source verification of your license to another state licensing agency.

    Management of Drug Therapy - Professional Liability Insurance for the Institutional Setting (PDF)

    Management of Drug Therapy - Professional Liability Insurance for the Non-Institutional Setting (PDF)

    Pharmacy Closure Notice (PDF)

    Instructions for Reciprocating (PDF) 

    Act 114 Authorization to Administer Repackaged and Relabeled Medications Form (PDF)

    Act 114 Prescriber Consent Form (PDF)