Provider Rx Form Request

Home Provider Rx Form Request

We understand that writing a compound can be difficult. At Precision Compounding we provide as much support to our physicians as possible.

Each Form will contain our top 15-50 compounded formulations in that specialty. However, we can accommodate many formulations not shown on the request form. Please contact our friendly pharmacists directly at (516) 785-4774 Ext. 2 to discuss any off-form requests.

Mon - Fri 9:00AM – 6:00PM
Emergency Hours 24/7

Rx Request Form

    Should We Email Instructions Regarding How to Electronically Prescribe a Compound?
    NPI Number:
    Phone Number:
    Email Address:
    Fax Number:
    Specialty Form:
    Would you Like One of Our Friendly Pharmacists to Call You?
    Please help us eliminate spam by answering this question correctly:

    * We abide by HIPAA law and never share personal information.

    Need Additional Assistance? Contact Us Anytime!