Register for an Account

Registration will enable eligible healthcare professionals to request samples and savings offers, sign-up for webinars and updates.

*All fields are required unless marked optional.

Account Information

E-mail*

Confirm E-mail*

First Name*

Middle Initial

Last Name*

Create username*

You can use your E-mail address or create a username (5 character minimum). Once created, this username cannot be changed.

Choose a password*

Passwords must be at least 7 characters long and must contain at least one alphabetic and one non-alphabetic character.Non-alphabetic characters include numerals (0-9) and special characters (e.g. @. ?*).

Confirm password*

Security question*

Security questions will be used to confirm your identity if you forget your login information.

Security answer*

Address

Country*

Street Address

Enter an address associated with your prescribing license.

Street Address 2 (optional)

City Name

State

ZIP Code

Current License Information

Your license information is used to identify you in our database, and also to advise you if you are eligible to request product samples. If eligible, you may use our convenient online request system to have samples delivered.

License type

License number

Don't know your NPI? Find it now.

By completing this registration, you agree that GlaxoSmithKline will maintain the information you have provided for the purpose of professional communication and will contact you as needed to update or maintain your registration information. GlaxoSmithKline will not sell or share this information with third parties for their marketing purposes and will always provide you with the opportunity to change your e-mail preferences. Please read our complete privacy statement for more information.

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Important Notice

Register for an Account

Account Information

Address

Current License Information