VI Board of Pharmacy 
Pharmacy Technician License Initial / Renewal 2024-2025 
First: ______________________________  M.I. ______  Last: ________________________  License# _______ 
Please indicate your Pharmacy Technician license renewal category. 
1. PHARMACY TECHNICIAN TRAINEE (PTT) ____  
2. REGISTERED PHARMACY TECHNICIAN (RPT) ____ 
3. CERTIFIED PHARMACY TECHNICIAN (CPT) ____ Attach PTCB / NHA Copy 
4. CERTIFIED PHARMACY TECHNICIAN W/ IMMUNIZATION (CPTI)____ Attach PTCB / NHA & BLS Copy 
Are you newly certified? _____YES_____NO 
 
Cell phone# _______________________      Email Address: ___________________________________ 
Mailing Address: ____________________________________City: _________________ State: ____ Zip:_________  
Currently Practicing in the VI? _____Yes _____No 
 
EMPLOYMENT 
PHARMACY 
PIC 
BUS TEL# 
 
 
 
 
 
 
 
 
 
  
Please email your completed Pharmacy Technician license form to: BoardofPharmacy@doh.vi.gov; 
Credit Card Payments can be made at: https://doh.vi.gov/payments/  Initial/Renewal fees are as follows: 
PTT- $0 
RPT- $50.00 
CPT- $75.00 
CPTI- $100.00 
Signature ______________________________________      Date __________ 
FILLABLE FORM
MUST TYPE