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 form below and mail it to the address at the bottom of the page or fax it to (860) 706-1229.
- Pharmacist License Number
- Previous Name
- New Name
- Effective date of the change
- Please include any supporting documentation i.e. marriage license, copy of a driver's license, official court documents etc.
Address Change
To complete a change of address, please send an email to DCP.PharmacistLicense@ct.gov with the following information or complete the form below and mail it to the address at the bottom of the page or fax it to (860) 706-1229.
- Pharmacist License Number
- Previous Address
- New Address
- 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 form below and mail it to the address at the bottom of the page or fax it 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.)
- Pharmacist License Number
- Previous Employer
- New Employer
- Effective date of the change
Mailing Address
Department of Consumer Protection
Commission of Pharmacy
450 Columbus Boulevard, Suite 801
Hartford, CT 06103
Pharmacist Change Form
- Pharmacist Notification of Change Form - This form should only be filled out if you are unable to email the change of information as instructed above.