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Pharmacy Technician Application

Applicant Information
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    Place of Birth
    If not born in North Dakota, please select Out of State. If not born in the US, please select Out of Country.
    Contact Information
    Pharmacy Information
    Are you employed by a pharmacy in North Dakota?
    Certificates
    Please indicate your Name and City as you want it to appear on your Original Certificate.
    Graduation from an American Society of Health Systems Pharmacists Accredited Pharmacy Technician Program is required.
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      Certification by the Pharmacy Technician Certification Board [PTCB] or National Health Career Association [ExCPT] is required.
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        Any changes in the above information must be reported to the Board of Pharmacy Office immediately.