Application for Collaborative Pharmacy Practice

Please do not use the back button of your browser while you are in the form. If at any time you wish to exit the form, please click the "Exit" button located at the bottom of the page.

Application requires fee of $50.00 (per Rule §11-8-3.5) payable by credit card only.

Login

Please login below to access the online application. Remember to prefix your License Number with RP. Do not add a space between the prefix and the number.