Complaint Form

Name*
First Last
Address
Street Address Address Line 2 City State ZIP Code
Home Phone
Work Phone
Name of Pharmacist/Technician
First Last
Name of Pharmacy
Address
Street Address Address Line 2 City State ZIP Code
Write a detailed statement and list any records, reports, letters etc., relative to the complaint you are filing. The Board does not have jurisdiction over complaints involving rudeness, customer service, and/or pricing/billing disputes. Please send all supporting documentation to the Arkansas State Board of Pharmacy.
Please check signature below.*
- Signature of Complainant(s)
Email*
CAPTCHA