While pharmacological and behavioral treatments exist for smoking cessation, there are currently no best practices for helping adolescents quit smoking. This study aimed to reach consensus regarding pharmacist recommendations for adolescent smoking cessation. Using a three-round Delphi technique, pharmacists across the USA with experience working with adolescent substance use provided quantitative and qualitative feedback on recommendations. Forty pharmacists completed Round 1, 37 completed Rounds 2 and 3. In Round 1, 36 (90%) responses included the nicotine patch, gum, or lozenge. Ten recommendations were identified in Round 1: nicotine patch, nicotine gum, nicotine lozenge, bupropion SR, varenicline, quitline, smoking cessation program, counseling, behavioral approaches, and cold turkey. In Round 2, pharmacists were most likely to recommend smoking cessation programs (median=7 of 7, Interquartile range [IQR]=1) and least likely to recommend varenicline (median=3, IQR=3). In Round 3, consensus to recommend was reached on smoking cessation program (83.3% likely or very likely to recommend). Despite initially recommending nicotine replacement therapy in Round 1, by Round 3 most pharmacists were more likely to recommend behavioral treatments than pharmacological interventions for this patient population. Such preferences by pharmacists could influence the accessibility of various treatments to adolescent smokers