Request a new PPSID
Simply complete the form and we will send your PPSID by FAX after we process your request.
Pharmacy name 1
*
Pharmacy name 2
Contact name
Mailing Address 1
*
Mailing Address 2
City
*
Territory
*
Yukon
Saskatchewan
Quebec
Prince Edward Island
Ontario
Manitoba
British Columbia
New Brunswick
Newfoundland
Nunavat
Nova Scotia
Northwest Territories
Alberta
Country
*
Canada
USA
USA State
- None -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Postal Code
*
Fax
*
Telephone
Preferred language
*
English
Français
E-mail address
A valid e-mail address. All e-mails from the system will be sent to this address. The e-mail address is not made public and will only be used if you wish to receive a new password or wish to receive certain news or notifications by e-mail.