Pharmacist License by Examination Application Packet For (U.S. Graduates-Original License by Exam)
Pharmacist License by Examination Application Packet For (U.S. Graduates-Original License by Exam)
Pharmacist License by Examination Application Packet For (U.S. Graduates-Original License by Exam)
This is information to apply for a pharmacist license by examination for (U.S. graduates-
original license by exam). For more information visit our website.
General Information
1. You must be a graduate of an accredited United States pharmacy school or college.
2. Washington State uses the North American Pharmacist License Exam (NAPLEX)
to test your knowledge, judgment and skills as an entry-level pharmacist. Multistate
Pharmacy Jurisprudence Examination (MPJE) tests you on both federal, state laws
and rules.
3. The Pre-NAPLEX practice examination is available on the National Association of
Boards of Pharmacy (NABP) website at https://nabp.pharmacy/.
4. You must submit a computerized exam registration form for both the NAPLEX and
MPJE at https://nabp.pharmacy/ or mail it to 1600 Feehanville, MT. Prospect
IL 60056. You may complete the registration forms and submit the payment by
credit card, VISA or Master Card, at the NABP Website. If you do not have a credit
card and prefer not to register online, you can get the paper registration forms by
sending a request with your name and address to our Customer Service Office at
hsqa.csc@doh.wa.gov, or by calling 360-236-4700.
5. To receive your Authorization to Test (ATT):
• Register with and pay exam fees to the NABP.
• Submit all items required before testing to our office.
Once the above steps have been completed, WA Pharmacy Quality Assurance
Commission will then release your name to the NABP as “ready to test”. The
NABP will send your ATT.
• We will notify you of your test results. Contact Office of Customer Service at
360-236-4700 if you have questions about licensure in Washington State.
6. Reporting intern hours: The commission accepts internship hours completed
as part of an ACPE accredited college/school of pharmacy, when reported
directly from the college/school of pharmacy or certifying state Pharmacy Quality
Assurance Commission.
Washington students must earn 300 internship hours independent from the
accredited college/school of pharmacy curriculum. Qualifying internship hours
are earned under the personal supervision of a preceptor or licensed pharmacist,
in a licensed pharmacy in the United States. The pharmacist’s license and
preceptor certification (if applicable) is active and in good standing. Use the
Preceptor Evaluation and Certification of Experience and Intern Site Evaluation
forms to report these hours to the Washington State Pharmacy Quality Assurance
Commission for each location.
Requirements Checklist
This is information to apply for a Pharmacist License by Examination for (U.S. Graduates-
Original License by Exam)
Note: Use this checklist as a tool to track information as you send items to the commission.
Name _______________________________________________________________________
Address _____________________________________________________________________
Address
Country
Email address:
Country
Note: The mailing and email addresses you provide will be your addresses of record. It is your
responsibility to maintain current contact information on file with the department.
Have you ever been known under any other name(s)? Yes No
If yes, list name(s):
Will documents be received in another name? Yes No
If yes, list name(s):
DOH 690-233 March 2017 Page 1 of 5
2. Personal Data Questions Yes No
1. Do you have a medical condition which in any way impairs or limits your ability to practice your
profession with reasonable skill and safety? If yes, please attach explanation.........................................
“Medical Condition” includes physiological, mental or psychological conditions or
disorders, such as, but not limited to orthopedic, visual, speech, and hearing impairments,
cerebral palsy, epilepsy, muscular dystrophy, multiple sclerosis, cancer, heart disease, diabetes,
intellectual disabilities, emotional or mental illness, specific learning disabilities, HIV disease,
tuberculosis, drug addiction, and alcoholism.
If you answered yes to question 1, explain:
1a. How your treatment has reduced or eliminated the limitations caused by your medical condition.
1b. How your field of practice, the setting or manner of practice has reduced or eliminated the
limitations caused by your medical condition.
Note: If you answered “yes” to question 1, the licensing authority will assess the nature,
severity, and the duration of the risks associated with the ongoing medical condition
and the ongoing treatment to determine whether your license should be restricted,
conditions imposed, or no license issued.
The licensing authority may require you to undergo one or more mental, physical or
psychological examination(s). This would be at your own expense. By submitting this
application, you give consent to such an examination(s). You also agree the
examination report(s) may be provided to the licensing authority. You waive all claims
based on confidentiality or privileged communication. If you do not submit to a
required examination(s) or provide the report(s) to the licensing authority, your
application may be denied.
2. Do you currently use chemical substance(s) in any way which impair or limit your ability to
practice your profession with reasonable skill and safety? If yes, please explain.....................................
“Currently” means within the past two years.
“Chemical substances” include alcohol, drugs, or medications, whether taken legally or illegally.
3. Have you ever been diagnosed with, or treated for, pedophilia, exhibitionism, voyeurism or
frotteurism?................................................................................................................................................
4. Are you currently engaged in the illegal use of controlled substances?....................................................
“Currently” means within the past two years.
Illegal use of controlled substances is the use of controlled substances (e.g., heroin, cocaine)
not obtained legally or taken according to the directions of a licensed health care practitioner.
Note: If you answer “yes” to any of the remaining questions, provide an explanation and
certified copies of all judgments, decisions, orders, agreements and surrenders. The
department does criminal background checks on all applicants.
5. Have you ever been convicted, entered a plea of guilty, no contest, or a similar plea, or had
prosecution or a sentence deferred or suspended as an adult or juvenile in any state or jurisdiction?....
Note: If you answered “yes” to question 5, you must send certified copies of all court
documents related to your criminal history with your application. If you do not
provide the documents, your application is incomplete and will not be considered.
If you have been granted certificate(s) of restoration of opportunity, please
provide a certified copy of each certificate.
To protect the public, the department considers criminal history. A criminal history
may not automatically bar you from obtaining a credential. However, failure to report
criminal history may result in extra cost to you and the application may be delayed
or denied.
5. Professional Experience
List in date order, most recent to later, all your professional experience. Attach additional completed pages if you
need more space.
Name and location of institution Type of experience start (mm/yyyy) end (mm/yyyy)
Dated___________________________________ By:________________________________________
(mm/dd/yyyy) (Original signature of applicant)
Name of Preceptor:
Name of Preceptor
Street Address
Note: Internship hours will not be accepted after the signature date.
RCW/WAC Links
Uniform Disciplinary Act, RCW 18.130
Administrative Procedure Act, RCW 34.05
Administrative Procedures and Requirements, WAC 246-12
Pharmacy Laws, RCW 18.64
Pharmacy Rules, WAC 246-863
Online
AIDS Training Resources, Reference Page
Pharmacy Quality Assurance Commission, Web Page