Pharmacy Board 3388 Brentwood Dr Baton Rouge, LA Drug: Fill out & sign online

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Click ‘Get Form’ to open the Pharmacy Board application in the editor.
Begin by filling out Section 1, Permit Information. Enter your pharmacy name, permit number, physical address, city, state, ZIP code, and email address. Ensure that the email provided can be used for official communications.
In Section 1, respond to the Special Survey questions by selecting 'Yes' or 'No' as appropriate for your pharmacy's operations regarding compounding and dispensing.
Proceed to Section 2 and answer the survey questions about vacancies for pharmacists and certified pharmacy technicians. Indicate the number of unfilled positions if applicable.
In Section 3, disclose any disciplinary history by answering the questions truthfully. If you answer 'Yes', prepare to attach a letter of explanation and a certified copy of any disciplinary action.
Complete Section 4 by calculating your total fees due. Decide whether to opt-out of the pharmacy education support fee if desired.
Finally, sign and date Section 5 to attest that all information is accurate. Ensure that the signature is from the Pharmacist-in-Charge.

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