Board of Pharmacy - Applications & Forms

Effective March 1, 2019, the Office of Professional and Occupational Regulation (OPOR) will no longer issue paper license verifications. License verifications are available, free of charge, on OPOR’s official database, https://www.pfr.maine.gov/ALMSOnline/ALMSQuery/Welcome.aspx?board=4380. This database is updated in real time as changes occur. The Office of Professional and Occupational Regulation considers this information to be a secure, primary source for license verification.

Many of our services are now available online:

• Apply for a License This option includes licensure applications for: Pharmacy Technicians, Pharmacy Interns, Pharmacist, Certificate of Administration of Drugs and Vaccines, Collaborative Drug Therapy Management, Prescription Drug Manufacturers, Opioid Prescription Drug Manufacturers, Mail Order Pharmacy and a Pharmacy located in the State of Maine
• Pharmacy PIC Change (for currently licensed Maine pharmacies)
• Renew a License
• Reinstate a License This option is only available to a person whose license to practice pharmacy in this State has been suspended, revoked, or restricted
• Obtain a License Verification Effective March 1, 2019 the Office no longer issues paper license verifications. License verifications are available, free of charge online.
• Check the Status of an Application and Submit Additional Documentation Online
• Update Contact and License Information change your contact information, employer information, corporate officers, shareholders, opioid production information, Pharmacy PIC change (for currently licensed Maine pharmacies)
• Upload Documents Select this option to file prescription drug reports, treatment protocols (written standing orders), collaborative agreements, vaccine clinic written plan of operation or liability insurance
• Change Account Information Individual Licensees Only, Change your password or secret question. This option is not available for companies
• Additional Options for Manufacturers of Opioid Prescription Drugs - This option includes options relating to opioid production, sales, and distribution
• Additional Options for Manufacturers of Insulin Products - This option includes options relating to insulin production, sales, and distribution
• Request a Copy of my License
• Request a Name Change
• Verify a License

Applications and Forms

Individual Pharmacist Applications

• Pharmacist by Score Transfer (PDF)The option to apply is available online which will expedite licensure.
• Pharmacist Reciprocity/Endorsement (PDF)The option to apply is available online which will expedite licensure.
• Certificate of Administration of Drugs and Immunizations (PDF)The option to apply is available online which will expeditelicensure.
• Collaborative Drug Therapy Management (PDF)The option to apply is available online which will expedite licensure.
• PIC change (PDF) (for currently licensed Maine pharmacies) The option to apply is available online which will expeditelicensure.
• Reinstatement Pharmacist (PDF)The option to apply is available online which will expedite licensure.
• Reinstatement of Certification of Administration of Drugs and Vaccines (PDF)The option to apply is available online which will expedite licensure.

Pharmacy Intern Applications

• Pharmacy Intern (PDF) (Educated in the U.S. or Canada) The option to apply is available online which will expedite licensure.
• Pharmacy Intern (PDF) (Educated in a Foreign country other than Canada) The option to apply is available online which will expedite licensure.
• Registration for Authorization to Administer Immunizations (PDF) (An active Pharmacy Intern license is required to register) The option to apply is available online which will expedite licensure.

Pharmacy Technician Applications

• Pharmacy Technician (PDF)The option to apply is available online which will expedite licensure.
• Pharmacy Technician (PDF) - Applicable only to the following persons employed by an Opioid Treatment Program and who holds a valid license issued by the State Board of Nursing; Advanced practice registered nurse, Registered professional nurse and Licensed practical nurse
• Registration for Authorization to Administer Immunizations (PDF) (An Active Pharmacy Technician license is required to register)

Business Applications

• Mail Order Contact Lens Supplier (PDF)
• Mail Order Prescription Pharmacy (PDF)The option to apply is available online which will expeditelicensure.
• Mail Order PIC change (PDF) - (for currently licensed Out of State Mail Order Pharmacies)
• Manufacturer (PDF)The option to apply is available online which will expeditelicensure.
• Opioid Prescription Drug Manufacturer - If the company manufacturers opioid medication products for distribution in the State of Maine you must apply online for the Opioid Prescription Drug Manufacturer using the Online Services tab. Please note you must submit a manufacturers application before applying online for the Opioid Prescription Drug Manufacturer license.
• Pharmacy (PDF) (located in the State of Maine) The option to apply is available online which will expedite licensure.
• Pharmacy PIC change (PDF) (for currently licensed Maine pharmacies) The option to apply is available online which will expedite licensure.
• Retail Supplier of Medical Oxygen and Oxygen Devices (PDF)
• Rural Health Center (PDF)
• VAWD Accredited Wholesaler (PDF)
• Wholesaler (PDF) (Not VAWD Accredited)
• Vending Machine Change of Location Reporting Form (PDF)The option to apply is available online which will expedite licensure.
• Reporting Jurisdictions of Licensure (PDF)

Active and Retired Military and Military Spouses

• Temporary License for Active Duty Service Members, Veterans Recently Separated from Service and Their Spouses/Domestic Partners(PDF)
• Click here for more information and resources

General Reporting Forms

• Drug Theft-Loss-Unresolved Report (PDF)
• Intern Experience (PDF) (Reporting Form)
• Reporting Authorized Persons or Authorized Technicians (PDF)

Other Forms

• Continuing Education (PDF)
• Replacement License Request Form (PDF)
• Verification request form to send to other states (PDF)
• Pharmacy Inspection Form - General (PDF)
• Pharmacy Inspection Form - Rural Health Centers (Pharmacy Services) (PDF)
• Credit Card Authorization Form (PDF) - To authorize payment of fees by Visa, MasterCard, American Express or Discover.
• No Social Security Number Affidavit (PDF)