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Board of Pharmacy - Applications & Forms

 

Individual Pharmacist Applications

• Certificate of Administration of Drugs and Immunizations
• Pharmacist Exam
• Pharmacy Retake Exam
• Pharmacist Reciprocity/Endorsement
• Pharmacist by Score Transfer
• PIC change (for currently licensed Maine pharmacies)
• Reinstatement Pharmacist

Pharmacy Technician Applications

• Pharmacy Technician
• Pharmacy Technician Advanced
• Pharmacy Technician Student (not for IPPE, APPE or Graduates)
• Pharmacy Technician - Student Pharmacist - Introductory Pharmacy Practice Experience (IPPE)
• Pharmacy Technician - Student Pharmacist - Advanced Pharmacy Practice Experience (APPE)
• Pharmacy Technician - Student Graduate

Business Applications

• Mail Order Contact Lens Supplier
• Mail Order Prescription Pharmacy
• Mail Order PIC change (for currently licensed Out of State Mail Order Pharmacies)
• Manufacturer
• Pharmacy (located in the State of Maine)
• Pharmacy PIC change (for currently licensed Maine pharmacies)
• Retail Supplier of Medical Oxygen and Oxygen Devices
• Rural Health Center
• Wholesale Distributor
• Reporting Jurisdictions of Licensure

General Reporting Forms

• Controlled Substance Destruction Log
• Drug Theft-Loss-Unresolved Report
• Internship Affidavit
• Preceptor Statement
• Reporting Authorized Persons or Authorized Technicians

Other Forms

• Continuing Education
• Verification of Licensure Request Form
• Replacement License Request Form
• Verification request form to send to other states
• Pharmacy Inspection Report
• Credit Card Authorization Form
  To authorize payment of fees by Visa or MasterCard.

 

If you cannot find what you are looking for, click HERE to send an e-mail message to the Board of Pharmacy.

 

Last Updated: October 3, 2011

About This Board

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Examinations

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Continuing Education

• Application Form
• Continuing Education Courses

contact us

• Board of Pharmacy
• 35 State House Station
• Augusta, ME 04333-0035
• Phone: (207) 624-8620
• Fax: (207) 624-8637
• TTY: (888) 577-6690
• Program Staff

Proposed Rule Changes

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