Welcome to MyPracticeConnect®

Thank you for joining out network of providers and compounding pharmacies. We are excited to assist your practice grow!

Please complete the form below so we can activate your provider account.
This information ensures your prescribing profile is set up correctly in our secure eRx system.

If you have any questions or need help completing this form, please reach out to our support team before submitting to ensure your platform setup is not delayed.

Practice Legal Name *

Practice Phone *

Practice Email *

Address

Street Address *

City *

State *

Country

Postal Code *

Provider Name *

Please ensure that the provider’s ID.me email address entered below matches the one used to sign in to their ID.me account. Providing an incorrect or different email will delay the setup of the platform account. If you are unsure of the provider’s ID.me email, confirm it before submitting this form.

If the provider does not yet have an ID.me account, they can create a free personal account at ID.me and then provide that email address here.

Provider ID.me Email *

Provider DEA Status *

Need Assistance?

Call

866-801-8411

Email

[email protected]