1. Attach a copy of the legal name change document (ex. marriage certificate, notarized court document, etc.). CSA Registrants Only: Attach a copy of your professional license that reflects the name change has been completed by your primary licensing board.
2. Complete and submit the online form
3. Pharmacists Only: New original license certificates are $20 each, payable by check or money order. Please mail your payment with a request for a duplicate wall license, a copy of this form, and the address where you would like it mailed.