EPCS/PDMP/InfinID Provider Registration

Please fill out the form below.

Clinic/Orginization Information *

Clinic/Orginization Address *

City *

State *

Zip Code *

Product *

First Name *

Last Name *

Email *

NPI Number *

DEA Number *

EPCS Hard Token Required? *

Yes

No

Ship to Same Address Above? *

Yes

No

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need help?

Email, give us a call, or fill out our contact form here.

Email

Phone

(888) 435-4194

need help?

Email, give us a call, or fill out our contact form here.

Support Email

Phone

(888) 435-4194