Application for Pharmacy Technician Trainee Licensure



Applicant Information

SSN (Pursuant to A.R.S. § 25-320)
Date of Birth
Have you ever been known by any other name?
Have you ever been licensed or certified to practice any profession or occupation in this state or any other state?
Are you currently employed in a pharmacy?
Are you currently enrolled in a pharmacy technician training program?

Regulatory Questions

Arizona Statement of Citizenship and Alien Status for Public Benefits


Review Your Information

Affirm And Submit

Please note that after you click the Submit button, you cannot make changes to your application.

Mailing Address: P.O. Box 18520, Phoenix, AZ 85005 Phone: (602) 771-2727

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