How to WRite a Valid

 prescription form

The Following Information is Needed for a Prescription: 

  • Prescriber Info: First Name, Last Name, Address, Phone, and Fax. NPI and DEA.

  • Patient Info: First Name, Last Name, Date of Birth, Address (Cannot be a P.O. Box) and Cell Phone Number/Email

  • Prescription Information: Drug Name, Strength, Quantity to dispense, Dosage Form, Directions, and Refills.

  • Cream Preparations: Indicate the dose and we will calculate the concentration. If this is a compounded formula, that needs to be indicated on the prescription. A statement explaining that the patient requires the compounded product should also be included. We will also need date of issue or prescription signed. Please review the link for more instructions. 

  • Prescriber Signature: Please include a prescriber signature for all controlled substances. Stamps and electronic signatures faxed in are not considered valid by the DEA.

Florida, New York, and Iowa now require electronic prescribing for all prescriptions.

how to send in a prescription

Phone

Call 800-995-4363 to speak with a customer service, pharmacy technician.

Fax

Fax our Toll-Free number 

800-985-4363 for submission. 

We will reach out to you if

additional information is needed

MyAnazao

Our online portal gives you the change to write, track, and order for your patients.

More Information

For more information, or to place an order, place call our Customer Service Department at 800.995.4363 or email info@anazaohealth.com