Individuals are required to report to the Board, within ten days, a change of name, address, or pharmacy employment.
Changes to your address, email address, phone number, and employment may be made through your online profile.
Name changes can be made using the Individual Licensee/Registrant Online Notification of Name Change form. To change your name you must attach a copy of the legal name change document (name change petition, marriage certificate, divorce decree, etc.)
Criminal Conviction or Disciplinary Action Notifications
A licensee who has been convicted of, or entered a plea of guilty, nolo contendere, or no contest to, a crime, other than a minor traffic offense, shall report such conviction or plea to the board within 30 days of adjudication.
A licensee who has been the subject of disciplinary action in another state, to include but not be limited to citations, reprimands, fines, license restrictions, probation, or license surrender, suspension, or revocation, shall report such action to the board within 30 days of adjudication.
Criminal convictions or disciplinary action can be submitted to Melanie Givens.