Provider Registration – NEXMED CARE LLC

Register to purchase from us by completing the brief form below. We will contact you shortly if there is any additional information needed. Once approved, you will have access to registered-only product information, as well as the ability to purchase, choose shipping, payment method and receive your UPS tracking number online.

First name *

Last name *

Business Name (Exact spelling required if pmt method is eCheck) (optional)

Country *United States (US)

Street Address / Shipping Address *

Apartment, suite, unit etc. (optional) (optional)

Town / City *

State *

ZIP *

Phone *

Website *

Email address *

Choose Password *

Confirm Password *

NPI *

Your personal data will be used to support your experience throughout this website, to manage access to your account, and for other purposes described in our privacy policy.

I acknowledge that purchases of disposable medical devices may not be returned for any refund, and that all sales are final, excluding a formalized manufacturer recall/warranty issue.

I acknowledge that my organization or group practice has sole responsibility for proper coding and billing to the patient’s insurance(s).

The above information is complete and correct to the best of my knowledge.

I have read and accept all of the foregoing. *