Change Font Size:
S
M
L
XL
Home
News
Calendar
About
Contact
CSAPP
WVPRN
Toggle navigation
West Virginia
Board of Pharmacy
Practitioners
Application Status
Renewal Status
Change of Name/Address
Reprint Request
Employment Update
Verification Request
Forms & Links
Practitioners Overview
Interns
Overview
Application
Renewal
Pharmacy Technician Trainees
Overview
Application
Extension
Pharmacy Technicians
Overview
Application
Renewal
Nuclear Pharmacy Technicians
Overview (Nuclear Tech Trainee)
Overview (Nuclear Tech)
Application
Renewal
Pharmacists
Overview
Application
Renewal
Consultant
Immunization
Collaborative Pharmacy Practice
Facilities
Application Status
Renewal Status
Change of Name/911 Address
Reprint Request
Verification Request
Forms & Links
Facilities Overview
In-State
In-State Facilities
In-State Pharmacies
In-State Controlled Substance Permit
In-State Mail Order Pharmacy
In-State Wholesale Drug Distributor
In-State Manufacturer
Non-Resident
Non-Resident Facilities
Non-Resident Mail Order Pharmacy
Non-Resident Wholesale Drug Distributor
Non-Resident Manufacturer
Non-Resident Third-Party Logistics Provider
Non-Resident Schedule V Pseudoephedrine Distributor
Public
File a Complaint
Licensee Verification
Request for Continuing Pharmacy Education Credit
About
About Us
Meet the Board
Meet the Staff
Meet the Inspectors & Investigators
Board Meeting Agendas
Board Newsletters
Annual Reports
Laws
Law Book Request
Most Recent Law Editions
Pharmacy Law and Rules
News
Board Newsletters
All News
Board Meeting Minutes
Application for Initial License as a Registered Intern
Personal Information
First Name:
Middle Initial:
Last Name:
Suffix:
Please select
II
III
IV
Jr
Sr
V
Maiden Name:
Gender:
Please select
Female
Male
Unknown
Date of Birth:
Social Security Number:
Place of Birth:
NABP e-Profile ID:
If you do not know your NABP e-Profile ID, please go to the
NABP site
to look it up.
Upload a 3x4 inch head and shoulders photograph.
Upload File(s)
Click
here
for recommendations on uploading files.
Submit & Continue
Save for Later
Exit