Join MyPharmAssist

Join as a Pharmacy

As each pharmacy has its own needs and specific goals it is looking to achieve, we like to customize our quotes to the individual pharmacy. Please fill out the information below and we will create a custom quote for your pharmacy. Within a few days, this will be returned via email to the Pharmacy Contact listed below. We hope MyPharmAssist.org can help bring your pharmacists right to your patient's medicine cabinet.

Fill out the form below to join, fields marked with an asterisk (*) are required.

Pharmacy Information

* Pharmacy Name:

*Pharmacy Contact First Name:

*Pharmacy Contact Last Name:

Login Information

* Email Address: (Your email address will be used as your username for logging into the site. Please use a valid email address, as a verification will be sent to this email address to activate your account after registration.)

* Password:

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(Please type a password between 12-16 characters that contains at least one capital letter, one number and one special character.)

* Retype Password:

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(Please retype the same password again.)

* Password Hint: (Your hint will be emailed to you in case you forget your password - we will NEVER email your actual password.)

Address Information

* Address:

* City:

* State:

Please choose... Arkansas Iowa Missouri North Dakota Ohio South Dakota Tennessee Vermont Virginia West Virginia

(Quick Questions and Video Conferencing are able to operate in the following states: Arkansas, Iowa, Missouri, North Dakota, Ohio, South Dakota, Tennessee, Vermont, Virginia, West Virginia. Our hope is to continue to expand into states that allow pharmacists to operate in this way. If you are a patient and do not reside in one of the above states, you are welcome to utilize the My Meds section but will be unable to participate in Quick Questions or Video Conferencing.)

* Zip:

* Phone Number:

Tell us more about your Pharmacy

* Number of Pharmacy Employees: (Each user will have their own individual login that will show their work within the system. The number above needs to include the total number of employees that will be utilizing MyPharmAssist.org. This can be pharmacists and/or technicians based on your pharmacy's preference and needs.)

Do you have any other questions/comments about our service?

Only accept questions/consultations for current patients? Please only allow scheduling for current patients. (If you only want to allow current patients to schedule consults/questions, please check this box.)

Areas of Specialty

Check all of the following areas that apply to you:

Cardiology

Diabetes Management

Durable Medical Equipment

Geriatric Pharmacy

Herbal Therapy

Infectious Disease Management

Nutrition Support

Oncology

Pain Management

Pediatric Pharmacy

Psychiatric Pharmacy

If you have any other specialties not listed above, please list them here:

Verification

* Check the box to prove you're human:

* By checking this box, you indicate that you have read and accepted the Terms of Use and Privacy Policy for this website.

Complete Registration