Partner Registration

ACCOUNT REGISTRATION

Provider Registration

Register with Reliance Rx Pharmacy. To create a new account, please fill in your first name, last name, email, and password. Make sure all fields are completed before submitting.

Note: Your email address will be set as your username when logging in.

Password Requirements:
- At least 10 total characters
- At least one lower case letter
- At least one upper case letter
- At least one number
- At least one special character

*Note: Membership to this site is public. Once your account information has been submitted, you will be granted immediate access to the site. All fields marked with a red asterisk are required. (Note: - Registration may take several seconds. Once you click the Register button please wait until the system responds.)

First Name:

Enter a first name.

Last Name:

Enter a last name.

Email Address:

Enter a valid email address.

Password:

Enter your password.

Confirm Password:

Re-enter the password to confirm.

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