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Forms Provided by the California State Board of Pharmacy

Click on the appropriate form to download

To Verify a Designated Rep or Wholesaler License:
Click on "Designated Representative", or "Wholesaler" depending on which license you are verifying, then enter the name of the person or business you need to check.

Designated Representative Application:
This form is supplied to you as part of the syllabus when you attend the APR Designated Rep Training Seminar

To change the Designated Representative-in-Charge:
Must be completed within 30 days of any change of DRIC

To change your name or address of record:
Must be completed within 30 days of change of name or address. This is for your personal designated rep certificate, not a wholesaler business license

To make changes to wholesaler or non-resident wholesaler permit:
Includes changes to company name, corporate officers, or business address

    Designated Representative Training Certification program approved by the California State Board of Pharmacy.
    © 2008 Access Pharmacy Resources: Pharmacy Training & Consulting. All rights reserved.
    17262 Hawkwood Drive| Riverside, CA 92503 | New Phone: 661-441-0919