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Arkansas State Board of Pharmacy
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Home > Licensee Information

Forms and Instructions

Page Content
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​Pharmacist Licenses/Permits Type​
Change of Pharmacist in Charge​ PDF​
Change of Pharmacist in Charge Extension Form​ ​PDF
License by Examination​ PDF​
License by Reciprocity​ PDF​
Nursing Home Consultant​ PDF​
Preceptor Application​ PDF​
Foreign Applicants​ PDF​
Administer Immunization Certification​ PDF​
​ ​
​Interns ​Type
Intern Application​ PDF​
Intern Training Plan​ PDF​
Affidavit of Experience​ PDF​
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Pharmacy Technicians​ Type​
Pharmacy Technician Application​ PDF
Pharmacy Technician Reinstatement​ ​PDF
​ ​
​Business Licenses Type​
Retail Pharmacy Application - In State​ PDF​
Retail Pharmacy Application - Out of State​ PDF​
Hospital Pharmaceutical Services​ PDF​
Institutional Pharmaceutical Services​ PDF​
Wholesale Distributor of Legend Drugs​ PDF​
Supplier of Medical Equipment, Legend Devices, and Medical Gas (DME license) ​ PDF​
Wholesale Distributor of List I Chemicals​ PDF​
Charitable Clinic Application​ PDF​
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Other Forms​ ​Type
CE Approval Request Form​ PDF​
CE Approval Request Form​ ​Word
Change Form​ PDF​
Closing of Pharmacy Form ​ PDF​
Complaint Form​ PDF​
Inspection Request Form​ PDF​
Order Form​ PDF​
Request for Waiver Form​ PDF​
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Arkansas State Board of Pharmacy
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Arkansas State Board of Pharmacy

101 E. Capitol - Suite 218

Little Rock, AR 72201

Phone: 501-682-0190 | Fax: 501-682-0195

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