Lic form 2026

1. Click ‘Get Form’ to open the lic form in the editor.
2. Begin by entering the Pharmacy Information. Fill in the Business Name and Physical Address of the pharmacy, ensuring accuracy as this information must match Box 2 on the Pharmacy Information Form.
3. Next, provide your Full Legal Name, Title, Date of Birth, Texas Pharmacist License Number, and Social Security Number. Remember that your home address is confidential and must be filled out completely.
4. Complete the Public Address section with an alternate address that can be shared publicly. You may use the same address as your home address if preferred.
5. If applicable, list any other professional licenses you hold by providing the License Type, License Number, State, and Expiration Date.
6. Answer all questions regarding professional disciplinary actions and criminal offenses truthfully. Ensure you provide additional details if necessary.
7. Finally, attest to the accuracy of your information by signing and dating the form. Remember that this signature must be notarized before submission.

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