ScriptPro Drug Information Form

To expedite the addition of product images to the database, please download the Drug Information Form PDF. Send the completed form, a product sample, and package insert (if available) to:

ScriptPro Industry Data Resources
5828 Reeds Rd
Mission KS 66202

Drug Information pre-paid mailers are available through Customer Service.

Download the Drug Information Form PDF

To submit a data request only, complete the following online form:


 * Required field
Pharmacy Name (as appears on DEA License):
*		 Contact Name:
* 
Street Address:
 Contact Email:
*
City, State, Zip:
 Contact Number:
NDC/DIN (exactly as it appears on drug package):
Stock Bottle Barcode/UPC (10 digits as on drug package):
Brand Name (only if Brand Product):
Generic Name:
*  
Strength/Unit (ex. 300/100 mg):
*  		 Dose Form (specify if EC/ER):
*
Distributor:
*		 Stock Bottle Size:
* 

 

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