Pharmaceutical Technician Application & Instructions
This application cannot be returned by fax or email.
We must have an original signature and fee to process.
Download application and mail to the address on the top of the application with the
required fee of $40.00. The fee is payable by
money order only
, we do not
accept personal or business checks, cash or credit cards. If the application is received
with a personal check or cash, it will be returned and will delay the processing of your
application.
Fee is made payable to : Nevada State Board of Pharmacy
Before calling with questions, please read all information carefully.
* If you only have a certificate from the Pharmacy Technician Certification Board
(PTCB) or National Tech Exam (ICPT) you will be required to work in Nevada as a
registered pharmaceutical technician in training for 500 hours. Please download the
application for a pharmaceutical technician in training. If you send in a pharmacy
technician application with PTCB or ICPT only, the application and fee will be returned.
You must include ONE of the following with the application:
* Copy of current registration or on-line verification from state in which you are
currently registered as a pharmaceutical technician. Your license in the other state
must be current to use for licensure in Nevada.
* Copy of a certificate from an ASHP approved pharmacy technician school. We
only accept pharmacy technician schools that are ASHP (American Society of Health
Pharmacists) approved. If your school is ASHP approved, the information will be
included on your certificate from the school.
Copy of non-ASHP school and PTCB or ICPT.
Upon receipt of application and fee, a certificate of registration can be sent directly to
you. You are not required to live in Nevada or have a job in Nevada to obtain
registration as a pharmaceutical technician. The application must contain an original
signature, no copies accepted.
All pharmaceutical technician registration expire October 31, of the even numbered
years, no matter when the license issued. It is your responsibility to keep us up to date
with your mailing address.
If you have any questions, please feel free to contact the Reno office at (775) 850-
1440.
NEVADA STATE BOARD OF PHARMACY
431 W Plumb Lane » Reno, NV 89509
PHARMACEUTICAL TECHNICIAN APPLICATION
Registration Fee: $40.00 - (non-refundable money order only, no cash)
Complete Name (no abbreviations):
First: Middle: Last:
Home Address: Apt #:
City: State: Zip Code:
Telephone: Social Security Number:
Date of Birth: Place of Birth: Sex: £ M or £ F
E-mail Address:
To qualify as a pharmaceutical technician you will need to meet one of the following criteria. Please check the appropriate
box and include the required documentation.
o Copy of registration or on-line verification from state in which you are currently registered as a pharmaceutical
technician.
o Copy of a certificate from an ASHP approved pharmacy technician school.
o Non ASHP approved school and PTCB or ICPT.
A licensee is not personally required to have a Nevada State Business License, however, if you have one, please provide
the number:
1. Are you 18 years of age or older? Yes £ No £
2. Are you a high school graduate or the equivalent? Yes £ No £
(IF YOU ANSWERED “NO” TO QUESTION 1 AND/OR 2, YOU CAN NOT SUBMIT THIS APPLICATION)
Yes No
Been diagnosed or treated for any mental illness, including alcohol or substance abuse, or
Physical condition that would impair your ability to perform the essential functions of your license?........o o
3. Been charged, arrested or convicted of a felony or misdemeanor in any state? ………………………………..o o
4. Been the subject of a board citation or an administrative action whether completed or pending in any sate?……..o o
5. Had your license subjected to any discipline for violation of pharmacy or drug laws in any state?...................... ….o o
If you marked YES to any of the numbered questions (3-5) above, include the following information & provide an explanation &
documentation:
Board Administrative
Action:
State Date: Case #:
/ /
Criminal
Action:
State Date: Case #: County Court
/ /
In response to federally mandated requirements , the Nevada Legislature and Attorney General require that we include the
following questions as part of all applications
Yes No
Are you the subject of a court order for the support of a child?......................................................................o o
IF you marked YES to the question, above are you in compliance with the court order?...............................o o
I hereby certify that the information furnished on this document is true and correct. I agree to abide by all the statutes, rules and regulations governing
pharmaceutical technicians and understand that a violation of any such statutes, rules and regulations may be grounds for suspension or revocation of this permit.
I understand that Nevada law requires a licensed PT who, in their professional or occupational capacity, comes to know or has reasonable cause to believe, a child
has been abused/neglected, to report the abuse/neglect to an agency which provides child welfare services or to a local law enforcement agency.
Original Signature, no copies or stamps accepted Date
Board Use Only: Date Processed: Amount:
