Saved Progress

If you are returning and used this feature, click "Log In" to pick up where you left off.

Company Information

Company Legal Name *

DBA (Doing Business As)

Username *

Bill to Street Address *

Bill to City *

Bill to State *

Bill to Zip Code *

Phone Number *

Fax Number *

Company Email *

Is the ship to address same as above? *

Ship to Street Address *

Ship to City *

Ship to State *

Ship to Zip Code *

EIN/Tax ID Number *

Years in business *

Type of ownership *

# of employees *

Type of business *

Please explain *

NCPDP Provider Number *

I don't have an NCPDP Provider Number

GLN

I don't have a GLN (Global Location Number)

***Note: The "Save Progress" feature will prompt you to create a username and password in order to save your progress for the application.

This username and password will ONLY be used for the application process.

Once your application is submited and approved, a brand new username will be created.

Phone: 888 688 1294

Fax: 888 688 1242

Email: Sales@PlentyRX.com

27524 Cashford Circle Suite 102

Wesley Chapel FL 33544