Become a provider

Thank you for your interest in partnering with GenoGenRx. The button below will take you to our onboarding form via DocuSign.

Have these ready before you begin signing:

  • Practice & License Info — practice name/address, state license number + expiration, NPI number

  • DEA Info (if applicable) — DEA number + expiration, secondary DEA/state, XDEA, Surescripts SPI

  • Contact Details — office/cell, fax and email.

  • Supervision & Sales Rep Info (if applicable)

  • Payment & Documents — a payment card to keep on file, plus a copy of State Medical License (required) and DEA Certificate (if applicable) to upload

Begin signing