Pharmacist License Change of Information
In accordance with Sections 20-576-10 and 20-576-11 of the Regulations of Connecticut State Agencies, you must notify the Commission of Pharmacy in writing, within five days, of any changes(s) of name, address or employment.
Name Change:
To complete a name change, please send an email to DCP.PharmacistLicense@ct.gov with the following information. Or, complete the Pharmacist Change Form provided on this page and mail it to the address at the bottom of the page, or fax to: (860) 706-1229.
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Pharmacist License Number
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Previous Name
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New Name
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Effective date of the change
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Please include any supporting documentation i.e., marriage license, copy of a driver's license, official court documents etc.
Address Change:
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Pharmacist License Number
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Previous Address
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New Address
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Effective date of the change
Change of Employment:
To complete a change of employment, please send an email to DCP.PharmacistLicense@ct.gov with the following information. Or, complete the Pharmacist Change Form provided on this page and mail it to the address at the bottom of the page, or fax to: (860) 706-1229. (Please note that if you are a pharmacy manager at the new location you will need to submit a Pharmacy Manager application also.)
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Pharmacist License Number
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Previous Employer
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New Employer
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Effective date of the change
Department of Consumer Protection