Online Application
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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