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California State Board of Pharmacy

On-line Change of Address Form

Complete the sections below, including the last four digits of your Social Security number, to report an address change.

Please be aware that the Board DOES NOT automatically issue a new license containing your new address. Please download the Application for Reissue of License if you would like to request an updated license and remember to include the appropriate fees for this service.

Be advised that your address of record is public information, even though it is not listed on the website. You may indicate an alternate address (i.e. your work address), if you prefer your residential address not be made public. Licensees using alternate addresses are still required by law to report their residential address although the information will not be made available to the public. Note: all correspondence from the Board will be mailed to the address of Record ONLY.

B & P 4100. Change of Address or Name - Notification to Board
(a) Within 30 days after changing his or her address of record with the board or after changing his or her name according to law, a pharmacist, intern pharmacist, technician, or designated representative shall notify the executive officer of the board of the change of address or change of name.

1704. Change of Address or Name - Notification to Board
Each person holding a certificate, license, permit, registration or exemption to practice or engage in any activity in the State of California under any and all laws administered by the Board shall file a proper and current residence address with the Board at its office in Sacramento and shall within 30 days notify the Board at its said office of any and all changes of residence address, giving both the old and new address.

For instructions on how to change your name with the Board of Pharmacy please visit the the Information for Licensees page on our website.

Please complete the following information. Note: Licensees must include the license number. If you do not know your license number please refer to the Board’s License Verification Screen to locate your license number.

Fields marked with an asterisk (*) are mandatory.

*I am a

*If a licensee

Personal Information as it is currently recorded with the Board

Address Change

*New Mailing Address:

Residence Address
(only if different from New Mailing Address above/ PO Box not acceptable)

*Previous Mailing Address:

I acknowledge that by providing the last four digits of my Social Security Number and by submitting this form, I declare under penalty of perjury under the laws of the State of California that the foregoing information is true and correct. Should I furnish any false information, I hereby agree that it shall constitute cause for denial, suspension or revocation of my license to practice in the State of California. I understand the Board is authorized to verify the information I have provided.

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