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PHARMACY NAME

PHONE NUMBER

EMAIL

PHARMACY CONTACT NAME

ADDRESS

Delivery Days Needed:

Select from Monday, Tuesday, Wednesday, Thursday, Friday, Saturday, Sunday, or all days. For other preferences, please specify.

Monthly Order Volume

Less than 100

101-200

201-300

301-400

Or 400+

Current Delivery Method

Own Driver

Third Party

Pharmacy Staff

No Delivery Offered Previously

Are Your Orders Mainly Local?

Select Yes or No. If No, please specify the location.

YES

NO

CHOOSE ONE OF THE FOLLOWING OPTIONS:

Recieve an immediate call

from eZypill to discuss your delivery needs

schedule a call

(Opens Calendly to schedule.)

Contacts

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Email

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