For additional information, please select the appropriate license/permit/registration to access the information page.
- These forms are not online applications and must be submitted by mail, or in-person, to the Kentucky Board of Pharmacy. Emailed applications may be submitted if utilizing an electronic signature.
- These applications contain fillable fields that can be used to type in your response (note: not all fields have a fillable box and may require a response).
- Applications submitted without your signature and date will not be processed and will be returned to you.
Professionals
Individual Information Change Form
Initial Application for Pharmacist Licensure
Pharmacist Renewal Application
Inactive Pharmacist Application/Renewal
Application for Pharmacist Certification for Opioid Antagonist Dispensing
Kentucky Reportable Disease Form
Pharmacist Intern Application
Pharmacist Preceptor Affidavit
Pharmacist Internship Report
Academic Experience Affidavit
Online Registration and Renewal
Pharmacy Technician Application
Pharmacy Technician Renewal Application
Charitable Pharmacy Technician Application
Charitable Pharmacy Technician Renewal Application
Application for Pharmacist CE Approval
Application for Provider CE Approval
Businesses
DEA 106 Form
Supplemental Information for Loss of Controlled Substance
Supplemental Information for Theft of Controlled Substance
Offsite Storage Request Form
Dual PIC Request Form
30 Day Temporary Dual PIC Request Form
PIC Change Form
Kentucky Reportable Disease Form
A Guide to Facility Ownership Changes
Opioid Antagonist Protocol
Resident Pharmacy Application [New, Change of location/address, Change of ownership, Name change]
Resident Pharmacy Renewal Application
Non-resident Pharmacy Application [New, Change of location/address, Change of ownership, Name change]
Non-resident Pharmacy Renewal Application
Clinical Practice Pharmacy Application [New, Change of location/address, Change of ownership, Name change]
Clinical Practice Pharmacy Renewal Application
Non-resident Clinical Practice Pharmacy Application [New, Change of location/address, Change of ownership, Name change]
Non-resident Clinical Practice Pharmacy Renewal Application
Medical Gas Pharmacy Application [New, Change of location/address, Change of ownership, Name change]
Medical Gas Pharmacy Renewal Application
Non-resident Medical Gas Pharmacy Application [New, Change of location/address, Change of ownership, Name change]
Non-resident Medical Gas Pharmacy Renewal Application
Charitable Pharmacy Application [New, Chage of location/address, Change of ownership, Name change]
Charitable Pharmacy Renewal Application
Non-resident Charitable Pharmacy Application [New, Change of location/address, Change of ownership, Name change]
Non-resident Charitable Pharmacy Renewal Application
Manufacturer Application [New, Change of location/address, Change of ownership, Name change]
Manufacturer Renewal Application
Annual Summary of Monthly Audits of Dialysate Solutions or Devices
Wholesaler Application [New, Change of location/address, Change of ownership, Name change]
Wholesaler Renewal Application
Third Party Logistics Provider Application [New, Change of location/address, Change of ownership, Name change]
Third Party Logistics Provider Renewal Application
Outsourcer Facility Application [New, Change of location/address, Change of ownership, Name change]