New Provider

Welcome to Emerald Compounding Pharmacy.

We’re honored to support your practice with custom-compounded medications and personalized pharmacy care. To establish your provider account, please complete the secure form below.

This form ensures we have the correct credentials, contact details, and preferences to collaborate safely and efficiently — all within a HIPAA-compliant framework.

What you’ll need:

  • Your professional and practice information

  • Licensing and credential details

  • Preferred contact method and pharmacy communication preferences

All submissions are encrypted and handled by our pharmacy team with strict confidentiality. For support, contact support@emeraldsrx.com or call our Provider Services line.

"*" indicates required fields

Name*
Your Email Address*
MM slash DD slash YYYY
MM slash DD slash YYYY
Which therapeutic areas are you interested in? Select all that apply.*
This field is for validation purposes and should be left unchanged.