Registration


Please fill out the Registration Application. This information will allow us to send messages, confirmations and shipping details. We also use it to verify all members are licensed pharmacists and/or owners. Once you complete it, you will be able to:

  1. Buy prescription drugs at discounted prices
  2. Post & sell your overstocked drugs to pharmacies all over the nation
  3. My Trader Rx will help you manage your inventory
  4. Better manage your inventory
  5. Increase your profit by turning your waste into cash

Once the application is submitted, we verify your status and you will receive an email validating your application. If you do not receive the confirmation message within few minutes of signing up, please check your Junk E-mail folder just in case the confirmation e-mail was delivered there instead of your inbox. If so, select the confirmation message & click Not Junk, which will allow future messages to get through.
Please complete required fields
Pharmacy Information
NPI # (0123456789) * :
Legal Business Name * :
Doing Business as (DBA):
Pharmacy Address 1 * :
Pharmacy Address 2:
Pharmacy City * :
Pharmacy Zip Code * :
Pharmacy State * :
Pharmacy Phone * :
Pharmacy Fax * :
Pharmacy License Information
DEA # (AB1234567) * :
State License Number * :
State License Expiration Date (MM/DD/YYYY) * :
Federal Tax Id # * :
Pharmacist Questionnaire
Enterprise Type # * :
Partnership
Corporation

Sole Proprietor
LLC
Primary Wholesaler Name * :
Secondary Wholesaler Name:
Type Of Pharmacy:
Pharmacy Owner Information
Owner First Name * :
Owner Last Name * :
Mobile Number * :
Email Address * :
Email Address (Confirm) * :
Pharmacy Contact Information
Referred by :
Pharmacies owned?:
Click here if Primary Contact Information is same as owner
Contact First Name * :
Contact Last Name * :
Title * :
Mobile Number * :
Email Address * :
Email Address (Confirm) * :
Terms and Conditions *
I accept the terms and conditions of the TraderRx.com User Agreement.