Register – Medi-Mate: Empowering Healthcare Through End-to-End Solutions

Account Name

Primary Prescriber

NPI

Phone Number

Rep

State License Number

E-mail Address

Fax Number

Clinic Address

Street Address

City

State

Zip Code

Mail Address

City

State

Zip Code

PLEASE PROVIDE A LIST OF ALL PRESCRIBERS THAT WILL BE SENDING PRESCRIPTIONS UNDER THIS CLINIC, ALONG WITH THE CORRESPONDING NPI NUMBERS

Additional Prescribers

NPI

Password

Confirm Password

Please note all payments for prescriptions are processed as the medication goes out. We will need to keep a credit card on file for these payments. Please indicate below how you would like to receive the statements.

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