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Clinic Partnership Application | TCP Compounding Pharmacy
Provider Network
Clinic Partnership Application
Join our provider network and offer tailored compounding solutions to your patients
Become a Provider
Clinic Partnership Application
Join our provider network · Tailored compounding solutions
Provider Information
First Name
*
This field is required.
Last Name
*
This field is required.
Credentials / Title
*
-- Select --
MD
DO
NP
PA
PharmD
DVM
Other
This field is required.
NPI Number
*
This field is required.
License State
*
-- Select --
TX
CA
FL
NY
IL
PA
OH
GA
NC
MI
Other
This field is required.
Email Address
*
This field is required.
Phone Number
*
This field is required.
Practice Information
Practice / Clinic Name
*
This field is required.
Street Address
*
This field is required.
City
*
This field is required.
ZIP Code
*
This field is required.
Specialty
*
-- Select --
Internal Medicine
OB-GYN
Dermatology
Oncology
Anti-Aging & Hormone Health
Pain Management
Pediatrics
Psychiatry & Mental Health
Veterinary Medicine
Other
This field is required.
Prescribing Needs
Compound Types of Interest
*
HRT / Hormone Replacement
Pain Management
Dermatology & Skincare
Weight Management
Thyroid Support
Pediatric Formulations
Mental Health / Psych
Veterinary Compounds
Please select at least one compound type.
Estimated Monthly Prescription Volume
*
< 25 Rxs
25–50
50–100
100+
Currently working with a compounding pharmacy?
Yes
No
Anything else you'd like us to know?
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Submit Application
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Application Submitted!
Our provider relations team will be in touch within 1–2 business days.
