Become a provider

Thank you for your interest in partnering with GenoGenRx. Fill in your information below to begin your application process via DocuSign.

*Currently shipping to patients in Florida only.

You’ll need these to complete your application:

  • 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

Have questions before applying?

Reach out to our team and we’ll be happy to help.

hello@genogenrx.com

(561)-760-1060