Registration Application Requirements & Forms

Resident In State Pharmacy

Registration Application Requirements & Forms

Application Requirements

An initial application must be submitted for each resident in state pharmacy in order to do business in New York. A completed application must be submitted with the required registration fee (see PH208 Checklist for Preliminary Registration of a Pharmacy (48 KB) for information on documents required). Make checks payable to the New York State Education Department. Note: Your cancelled check is your receipt.

You must answer all questions and provide all information requested unless otherwise indicated. Failure to complete all required parts of the application will delay its review. Submit applications directly to the Office of the Professions at the mailing address at the end of the form.

The burden of submitting a properly completed application rests with the applicant. We have provided detailed instructions to assist you. Please read them carefully.

If you are not sure about what is required, especially as it relates to corporate documents and filings, you may wish to consult with your attorney. You should also know that applications are processed in the order in which they are received. In the interest of fairness, we cannot deviate from this policy.

For pharmacies or establishments with sterile compounding, please submit your completed application at least 12 to 16 weeks before the planned opening or transfer of your pharmacy or establishment.

For pharmacies or establishments without sterile compounding, please submit your completed application at least 10 to 14 weeks before the planned opening or transfer of your pharmacy or establishment.

Applicants are urged to retain copies of all applications and documents submitted to the Pharmacy Board Office. Other agencies may require copies of applications for their registration. It is the applicant's responsibility to make and retain these copies. INCOMPLETE APPLICATIONS WILL BE RETURNED TO YOU FOR COMPLETION.

Application Forms

Note: All forms are in Adobe Portable Document Format (PDF). To view or print these documents, you will need to have the free Adobe Reader installed on your computer. Download times and print quality will depend on your connection speed and printer.

• Resident Instate Pharmacy Initial Registration or Transfer of Ownership of Pharmacy
  • Information and Instructions
  • Checklist of Documents Needed PH208 (48 KB)
  • Checklist of Items Needed for Inspection (118 KB)
  • Application PH200 (30 KB)
  • Pharmacy Information Form PH210 (33 KB)
  • References
    • Education Law, Section 6808 Registering and operating establishments
    • Regulations of the Commissioner of Education, Section 63.6 Registration and Operation of a New York establishment
  • Important Information and Application Forms on Expanded Syringe Access Demonstration Program (ESAP) from the Department of Health
     
• Resident Instate Pharmacy Change of Location, Renovation, Name, Officers and/or Owners

  Registered pharmacies must notify the NYS Board of Pharmacy whenever there is a change of location, renovation, change of name or change of officers and/or owners. See Instructions below for information on filing and fee requirements. In each instance, the appropriate documents and fee, if required, must be submitted to the Office of the Professions at the mailing address at the end of the form whenever these changes occur.

  • Resident Instate Pharmacy Change of Location
    • Instructions
    • Application PH202 (32 KB). Fee required.
    • Pharmacy Information Form PH210 (33 KB)
  • Resident Instate Pharmacy Renovation
    • Pharmacy Information Form PH210 (33 KB)
    • Instructions: The Pharmacy Information Form (PH210) for renovation should be completed and returned to this office, as soon as possible, with the following:
      1. Photographs of registered and renovated area.
      There is no charge for renovation
  • Resident Instate Pharmacy Change of Name
    • Instructions: The preliminary endorsement application (PH202) for change in corporate name should be completed and returned to this office, as soon as possible, with the following:
      1. Copy of Amended Certificate of Incorporation indicating change of corporate name.
      2. Copy of the Filing receipt from Secretary of State for name change.
      3. Wording of any outdoor sign you propose using for this establishment.
      4. Copy of proposed labels (pharmacy, manufacture and repackers).
      There is no charge for a name change.
    • Application PH202 (32 KB). No fee.
  • Resident Instate Pharmacy Change of Officers and/or Owners
    • Instructions: The application (PB327) for change in officers and/or owners must be completed and returned to this office, as soon as possible with the following:
      • A copy of current Driver's License or Passport is required for each new owner/officer/partner.
      There is no charge for a name change.
    • Notification Form PB327 (27 KB). Notarized, no fee.