WEST VIRGINIA BOARD OF PHARMACY
APPLICATION FOR LICENSE OR RENEWAL AS A 
REGISTERED PHARMACY TECHNICIAN
July 1, 2005 to June 30, 2007
232 Capitol Street, Charleston, West Virginia 25301 (304) 558-0558
Section 10, Article 5, Chapter 30 of the Code of West Virginia requires that every registered pharmacy technician within this state shall on or before July 1 apply to the State Board of Pharmacy for annual renewal of his or her certificate. Complete the following form, fill in all categories as required, return with the fee of $30 payable to the West Virginia Board of Pharmacy.
Note: Since last renewal, have you been convicted of any felony or infraction of pharmacy laws? _____ Yes _____ No
Make name and address corrections on reverse side Make the name and address of your employer below this line
 
 


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