Provider Access Application

Apply for a verified partner account to unlock the formulary, account pricing, and a dedicated rep. Complete the form below to begin verification.

Disclaimer

NB Biopharma provides account access exclusively to verified healthcare providers, licensed practices, and qualified research institutions for professional and laboratory research use. All orders must originate from authorized accounts and are supplied strictly for research and analytical purposes. NB Biopharma does not sell to patients or individual consumers, and all materials are distributed under research-use-only (RUO) classification.

Contact information

First name *

Last name *

Email *

Phone *

Business profile

Company / practice name *

Business type *

Website *

Tax ID / EIN *

NPI number *

State license number (optional)

DEA registration number (optional)

Does your business have a reseller's license? *

Helps determine your eligibility for sales-tax exemption.

YesNo

Business address

If not applicable, use your main operating address. All fields required.

Address line 1 *

City *

State *

ZIP code *

Verification & referral

Upload proof of business or professional license (optional)

PDF, JPG, PNG, or HEIC · up to 10 MB

Clinics may upload a business permit; individual providers a license or valid ID.

Referred by someone? Let us know (optional)

Anything else? (optional)

I confirm I am a licensed professional or authorized representative of a qualified institution, and that products are for research and analytical use only.

I agree to the Terms of Service and Privacy Policy.

By submitting, you consent to receive email and/or SMS communication from NB Biopharma regarding your account. Message frequency varies; message & data rates may apply.