Illinois RxSubmit Application
Illinois RxSubmit Registration
Create Login Credentials

Registration Tracking Id: {{registrationRequestId}}

Password must meet the following requirements:
  •   Minimum of 8 characters
  •   Contain one upper case letter
  •   Contain one lower case letter
  •   Contain at least one number
  •   Contain one special character (! @ # $ etc.)
  •   Maximum of 72 characters
Note: Phone verification is optional here as you can verify the phone number in profile page after login. In case you want to receive message in phone then please verify your phone number before registration.
Verify Role Verify (Role and Supervisor Email)
Basic Information
Password recovery requires a cell phone that receives text messages.
Professional Information
Please provide your DEA and NPI number.
Action License Number Expiry Date Status
{{x.license}} {{x.led}} {{x.message}} {{x.message}}
Action DEA Number Status
{{x.dea}} {{x.message}} {{x.message}}
Action NPI Number Status
{{x.npi}} {{x.message}} {{x.message}}
Employer Pharmacy Information
Additional Information