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Indiana Professional Licensing Agency

PLA > Professions > INDIANA BOARD OF PHARMACY > Licensee Information and Applications > Pharmacist Information > Name Change Information Name Change Information

If you have a legal name change and wish to change the name on your license, you will need to submit official documentation to verify the change.  This documentation includes a marriage license/certificate, social security card, or divorce decree.  The request for name change must be made in writing (including the official documentation) to our office by faxing 317.233.4236, e-mail to pla4@pla.IN.gov, or by mailing 402 W Washington Street Rm W072, Indianapolis, Indiana, 46204.  Your name change request must include your license number and how you want your name to read on your license. 

To receive an updated license with your changed name, please verify that the name change has been completed by our office at http://www.in.gov/pla/license.htm.  Once it has been updated, you may request a duplicate license to be issued to you at the same website.