Pharmacist Registration – MediConnect Partners

Pharmacy Information

Pharmacy Name *

Owner / Pharmacist Name *

Email Address *

Phone Number *

Drug License Number *

GST Number

Location & Delivery

Shop Address *

City *

Home Delivery Available?

Delivery Radius (km)

Required Documents

Upload clear photos or scans. PDF or Image, max 5MB per file.

Drug License (Form 20 & 21) *

Click to upload Drug License

PDF or Image, max 5MB

GST Registration Certificate

Click to upload GST Certificate

PDF or Image, max 5MB

Pharmacist Registration Certificate *

Click to upload Registration Cert.

PDF or Image, max 5MB

Owner Government ID (Aadhaar / PAN) *

Click to upload ID Proof

PDF or Image, max 5MB

Review Your Application

What happens after submission?

Our team reviews your pharmacy registration documents within 2–3 business days
You receive your Pharmacist User ID (MC-RX-XXXX) and temporary password
Log in at provider-login.html and set a new password
Start adding medicines to your catalog — they go live on MediConnect immediately!