Request for Renewal of Nebraska Pharmacy Technician Certification (NE-CPhT)
Renewal Fee is $50 if submitting at least 30 days prior to your certification expiration date.
$65 fee for late renewal (less than 30-days prior to your certification expiration date). Late renewal requests are not guaranteed to process by your certification renewal date.
Reinstatement Fee is $80 if your Certification has expired.
**You may not owe a renewal fee. Your renewal fee may have been included in the original Certification cost. Please contact Judy Neville for renewal fee questions. judy.neville@unmc.edu **
Important Note: Your recertification process will not begin until the College of Pharmacy has received your payment and supporting documents.
First Name *
Your answer
Last Name *
Your answer
Is there a name change from your original NE-CPhT certificate? *
Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Telephone Number *
Your answer
Email Address *
Your answer
NE-CPhT Certification Number *
Your answer
NE-CPhT Initial Certification Date *
MM
/
DD
/
YYYY
Nebraska Registration Number *
Your answer
Choose the practice setting that best describes your primary place of employment. *
Required
Next
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service