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Provider Information

Please fill out all fields possible. All fields marked with an * are required.

This is your primary company name, e.g. John’s Pharmacy or American Healthcare Co.
Add any unique identifier you use for your clients/client groups.
Information provided by www.usps.com

Account Credentials

You will use the following password to log in to the RxGenomix Portal.

Password needs to contain at least one upper, one lower, one number, one special character and 8 character minimum
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