Please answer each question to the best of your ability, this will ensure fast and easy account setup.
Please email the doctors DEA, State, and CDS license to info@physicianspurchasing.com
*By Submitting this application you are giving Physicians Purchasing LLC. permission to act as your purchasing agent. This also gives Physicians Purchasing LLC. the ability to sign any
non-legally binding paperwork necessary to achieve our goals on your behalf.
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