NC Board of Pharmacy Check List for Pharmacy Technicians

GUIDELINES FOR COMPLETING APPLICATION FOR NEW TECHNICIANS

*REMEMBER* IF YOU HAVE BEEN REGISTERED IN THE PAST AND ARE CURRENTLY INACTIVE, A COMPLETED REINSTATEMENT APPLICATION IS REQUIRED. REINSTATEMENT FEE IS $60.00.

1. Social Security number filled in (Required)

2. Date of birth filled in (Required)

3. Mailing address (If this is a PO Box, be sure to list separate from physical address)

4. Home phone number (with area code)

5. Place of employment AND PHARMACY PERMIT NUMBER (Required)

6. Date employment began as a technician

7. Training program

8. Pharmacist Manager’s license number, signature, and date (Required)

9. Technician’s signature and date (Required)

10. Attach Passport photo to Application

11. The $30.00 fee must accompany application or the application will be returned.