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Retail Program Location Reservation System

​Please choose a username and password (
*denotes a required field). After you complete this registration form a Medicare & Senior Solutions Sales Manager will contact you to activate your account.

​For assistance with this form, please contact 
Carolyn Portanova
 at 919.794.3179 or 800.928.4998 ext. 8.
Picture

    Please create a username that is between 6-20 alphanumeric characters.
    Please create a password that is between 6-20 alphanumeric characters.
    Look up your NPN via NIPR.

    When signing up for the in-store program, you agreed that SilverScript may communicate with you via text, and the cost of receiving such texts, if any, will be your responsibility. The frequency of text communication is expected to be less than 10 through the duration of the program. The primary purpose of text communication will be related to logistics and compliance. If you wish to opt out of text communication, send an e-mail request to ProducerSalesResource.
Submit

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1480 Chapel Ridge Road
​Suite 200
​Apex, NC 27502


​800.928.4998
919.489.3600
​919.419.0401 (fax)

[email protected]

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