| # | Order ID | Form | Name of Customer | Address | Status |
|---|---|---|---|---|---|
| 1 |
3f996197a6479726032a386f268cbe191743633901
04/02/2025 06:45 |
elysiumpharmaceuticals.com | MARTIN VEGA | 3501 Orchid Ct. Fort Smith, AR - 72904 | Completed |
| 2 |
7022a567e78d93ea92ad07dd966754ae1743630302
04/02/2025 05:45 |
elysiumpharmaceuticals.com | MARIELENA GOMEZ | 140 Pasadena Ave. Columbus, OH - 43228 | Completed |
| 3 |
59c47cde40adda3947d6cc094d24cd511743628502
04/02/2025 05:15 |
elysiumpharmaceuticals.com | FABIAN GOMEZ | 1185 Monroe St. Apt # 5A Salinas, CA - 93906 | Completed |
| 4 |
59c47cde40adda3947d6cc094d24cd511743628501
04/02/2025 05:15 |
elysiumpharmaceuticals.com | CRISTINA GOMEZ | 1185 Monroe St. Apt # 5A Salinas, CA - 93906 | Completed |
| 5 |
2f667bf47f100313e5d374a2905d4b271743626531
04/02/2025 04:42 |
PharmacyChiefs.com | William Byrne | 2914 Garfield Street Marne, MI - 49435 | Completed |
| 6 |
2f667bf47f100313e5d374a2905d4b271743626335
04/02/2025 04:38 |
PharmacyChiefs.com | Michael Ringquist | 139 Braxton Drive Statesville, NC - 28677 | Completed |
| 7 |
2f667bf47f100313e5d374a2905d4b271743626108
04/02/2025 04:35 |
PharmacyChiefs.com | Mary Robin Griffith | 954 Troon Circle Frankfort, IL - 60423 | Completed |
| 8 |
bbb62ed1609ef479e04ed1b7bb32521b1743624907
04/02/2025 04:15 |
elysiumpharmaceuticals.com | MARIO HERNANDEZ | 411 N Mars Ave. Clearwater, FL - 33765 | Completed |
| 9 |
bbb62ed1609ef479e04ed1b7bb32521b1743624902
04/02/2025 04:15 |
elysiumpharmaceuticals.com | MARIELA MORENO | 144 Rockledge Ln. Lake Arrowhead, CA - 92352 | Completed |
| 10 |
cf9c8dd9b384624509cf87dbe3a0b0b21743623101
04/02/2025 03:45 |
elysiumpharmaceuticals.com | Diane Trayner | 3765 Guinn Gate Dr Frisco, Texas - 75034 | Completed |
| # | Order ID | Form | Name of Customer | Address | Status |
|---|---|---|---|---|---|
| 1 |
b61a9f8d3db0520d3173b74cd389111f1743572982
04/02/2025 01:49 |
trimapill.com | * * * Claim Free iPhone 16 * * * hs=ff5e5795945c6ce0f8f99aa0ef4edf1a* Ñ… c1fmif | 40pzq9 173064441825 zlqaki, WY - 76517 | For Doctor's Approval |
| 2 |
b61a9f8d3db0520d3173b74cd389111f1743572967
04/02/2025 01:49 |
trimapill.com | * * * Unlock Free Spins Today: https://akashsteelcraft.com/?2u6ide * * * hs=ff5e5795945c6ce0f8f99aa0ef4edf1a* Ñ… 2zs9f9 | iiqu2n 358407318551 qiiy5l, WY - 05970 | For Doctor's Approval |
| 3 |
1ee5c211076d10c27d9763f46e886fe61743329555
03/30/2025 06:12 |
thinnex.com | * * * Snag Your Free Gift * * * hs=6778be9a876090195e2cbfdc0b00385a* 3y332p | gcjxpa 287765041310 qpha1s, WY - 78548 | For Doctor's Approval |
| 4 |
1ee5c211076d10c27d9763f46e886fe61743329540
03/30/2025 06:12 |
thinnex.com | * * * Unlock Free Spins Today: https://www.wedspair.com/?49lppd * * * hs=6778be9a876090195e2cbfdc0b00385a* jbpht4 | ssqtb3 750730017942 u1qh61, WY - 87669 | For Doctor's Approval |
| 5 |
31992eb1c9f6f3eab7a2d9babcb1a2d61741218768
03/05/2025 06:54 |
thinnex.com | Casi Talbott | 1832 Stone Coal Rd Salem, WV - 26426-8140 | For Doctor's Approval |
| 6 |
014b09af9b0c6f707c52786c3a96213c1741070141
03/04/2025 01:35 |
trimapill.com | * * * Snag Your Free Gift * * * hs=ff5e5795945c6ce0f8f99aa0ef4edf1a* kcumgp | twdxbt 418272656616 nfk711, WY - 34048 | For Doctor's Approval |
| 7 |
014b09af9b0c6f707c52786c3a96213c1741070136
03/04/2025 01:35 |
trimapill.com | * * * Unlock Free Spins Today: http://annaitheresaschool.com/upload/ypkcze.php?jphd4s * * * hs=ff5e5795945c6ce0f8f99aa0ef4edf1a* ieo59u | 6di9nn 193401021771 6vprnj, WY - 23483 | For Doctor's Approval |
| 8 |
d73eaf73c517ea7b8aaf3cac779810fc1740554118
02/26/2025 02:15 |
thinnex.com | * * * Claim Free iPhone 16 * * * hs=6778be9a876090195e2cbfdc0b00385a* s0buf9 | dt27ml 782516287616 qtpdxi, WY - 72063 | For Doctor's Approval |
| 9 |
d73eaf73c517ea7b8aaf3cac779810fc1740554114
02/26/2025 02:15 |
thinnex.com | * * * Claim Free iPhone 16: http://vasudevelectroproject.com/upload/wcbmcq.php?q0z7iwu * * * hs=6778be9a876090195e2cbfdc0b00385a* q9k5dk | tf87eq 905905078577 qw6dua, WY - 25312 | For Doctor's Approval |
| 10 |
61dfe7d1cf2cb76141079cdd36ae7c101740409792
02/24/2025 10:30 |
thinnex.com | denise dixon | 956 Carnegie Ave plainfield, AK - 07060 | For Doctor's Approval |
| 11 |
c14cbe5ea2b5e133c93db54a85c67db31740358955
02/23/2025 08:30 |
thinnex.com | Angela Lacayo | 3A Inwood Dr Spring Valley, AK - 10977 | For Doctor's Approval |
| 12 |
04c62c2c417d2f289ebe6f2fd62f26d31740294291
02/23/2025 02:04 |
thinnex.com | * * * Unlock Free Spins Today * * * hs=6778be9a876090195e2cbfdc0b00385a* qrpza0 | fcxs2r 145685981747 lpau7n, WY - 71011 | For Doctor's Approval |
| 13 |
04c62c2c417d2f289ebe6f2fd62f26d31740294288
02/23/2025 02:04 |
thinnex.com | * * * Claim Free iPhone 16: https://kapilgroup.com/uploads/cim2qx.php?7urcdoy * * * hs=6778be9a876090195e2cbfdc0b00385a* m66d5c | tl9pp7 941500438938 5bmbop, WY - 20528 | For Doctor's Approval |
| 14 |
37453e55d373337aa3d6467b08b285381739318028
02/11/2025 06:56 |
thinnex.com | Georgine Garcia | 9922 n Wayland Ave Citrus springs, FL - 34434 | For Doctor's Approval |
| 15 |
093d8d31dd3411012cb931dce92a84fe1739223870
02/10/2025 05:10 |
thinnex.com | Perry Jeter | 165 Via Veracruz Jupiter, FL - 33458 | For Doctor's Approval |
| 16 |
1738054541
01/28/2025 03:57 |
performanceinspired.com | TEST PERFORMANCE INSPIRED | 6M CLUSTER 31 CAMBRIDGE VILLAGE, BRGY. SAN ANDRES CAINTA, RIZAL, AZ - 1800 | For Doctor's Approval |
| 17 |
96bbef828b98e880196326846ef167c61736827263
01/13/2025 11:09 |
thinnex.com | JAY R Test if thinnex is active | 6M CLUSTER 31 CAMBRIDGE VILLAGE, BRGY. SAN ANDRES CAINTA, RIZAL, AK - 1800 | For Doctor's Approval |
| 18 |
72047a0e6c0132aac87d1ba2eb54aabb1736369289
01/08/2025 03:51 |
thinnex.com | Mahsa Sorey | 1200 Brickell Bay Dr APT 3509 Miami, FL - 33131 | For Doctor's Approval |
| 19 |
a71160df4c992bc49b8f3d3d71ddba6b1734921256
12/22/2024 09:37 |
back2actionchirorehab.com | Anna Garrison | 1392 East Lark Street Gilbert, AZ - 85297 | For Doctor's Approval |
| 20 |
1ebd2d5ef8e8b97eac4bc336b2987d051734287094
12/15/2024 01:27 |
gomymeds.com | Hamzah Ramawad | 730 Julia Street 408 New Orleans, LA - 70130 | For Doctor's Approval |
| 21 |
7eb748d87691eac4d570b59ee7109e451731003029
11/07/2024 01:13 |
eyralife.com | TEST TEST | 123 test Maiki, GA - 222333 | For Doctor's Approval |
| 22 |
a1107cb88f05685ef0a71c240b9060cd1730928544
11/07/2024 01:04 |
eyralife.com | Test Test | 123 miami Moamo, AK - 33333 | For Doctor's Approval |
| 23 |
ae605b8ebfc220a5bb8620d3fef005bf1730993478
11/07/2024 10:34 |
changewithrise.com | John Yuhanick | 16108 Baconsfield Lane Monkton, MD - 21111 | For Doctor's Approval |
| 24 |
125322ca0e618079ccd4cf0272c4a3321730944603
11/06/2024 09:00 |
eyralife.com | TEST TEST | 123 test dr Miami, FL - 33325 | For Doctor's Approval |
| 25 |
2acdc3f53dca4df6340a2fe377e4b0711730482025
11/01/2024 01:29 |
theurbanyou.com | Amy Klobucher | 6320 fisk meadow dr rockford, MI - 49341 | For Doctor's Approval |
| 26 |
023d8aec8decd5ac35e7e51fe5bc7edb1730142745
10/28/2024 03:14 |
eyralife.com | TEST TEST | 5257 sw Cooper City, FL - 33328 | For Doctor's Approval |
| 27 |
ca7a15608ce6ae2163f015240c89112c1729293207
10/18/2024 07:16 |
theurbanyou.com | jayne poyner | 20465 Lexington Blvd Northville, MI - 48167 | For Doctor's Approval |
| 28 |
34d8836433d129883d208670f62f6b5d1729108414
10/16/2024 03:55 |
thinnex.com | Test Test | 123 E Example St. Scottsdale, AZ - 85281 | For Doctor's Approval |
| 29 |
835a94e7afe1be842556a98c906f1df21729012677
10/15/2024 01:20 |
eyralife.com | TEST TEST | TEST TEST TEST, FL - 33024 | For Doctor's Approval |
| 30 |
cc090033b28bf0333aae42796835f04b1728749810
10/12/2024 12:19 |
theurbanyou.com | Hannah Earl | 1445 rosalind rd se Grand rapids, MI - 49506 | For Doctor's Approval |
| 31 |
e7d5d871991f949e7211a3da86da05551728588804
10/10/2024 03:36 |
theurbanyou.com | Lynn Diffell | 3435 Lake Dunes Drive Muskegon, MI - 49441 | For Doctor's Approval |
| 32 |
4643d5f7ca854166c0f76f59295796e11728495462
10/09/2024 01:39 |
eyralife.com | Santiago Eljaiek III | 8870 SW 63rd Court Pinecrest, FL - 33156 | For Doctor's Approval |
| 33 |
4a67e7a164e15a671e62dcf942e34d161727559094
09/28/2024 05:38 |
eyralife.com | Docmakori Makoris | 1819 West Ave Bay 6, Miami Beach, FL 33139, United States Miami Beach, AK - 33139 | For Doctor's Approval |
| 34 |
cc52fae8cd87e92d48945370c81350fb1727315498
09/25/2024 09:52 |
changewithrise.com | JAY R MAGDALUYO | 6M CLUSTER 31 CAMBRIDGE VILLAGE, BRGY. SAN ANDRES CAINTA, RIZAL, AK - 1800 | For Doctor's Approval |
| 35 |
6396beb1141285d8b9a2650041d015531727268520
09/25/2024 08:53 |
changewithrise.com | Test Test | 4705 S Adelle Circle Mesa, AZ - 85212 | For Doctor's Approval |
| 36 |
be160ca1703a400206c2930b7f72a0b51727268530
09/25/2024 08:50 |
changewithrise.com | Test Test | 16108 Baconsfield Lane Monkton, MD - 21111 | For Doctor's Approval |
| 37 |
106bde6095af9fec89253c0cd3743ff81725730936
09/07/2024 01:42 |
thinnex.com | Test test | 4705 S Adelle Cir Mesa, AZ - 85212 | For Doctor's Approval |
| 38 |
106bde6095af9fec89253c0cd3743ff81725574622
09/05/2024 06:17 |
thinnex.com | Test Test | 123 Example Mesa, AZ - 85212 | For Doctor's Approval |
| 39 |
1725360477
09/03/2024 06:49 |
trimapill.com | JAY R MAGDALUYO TRIMAPILL | 6M CLUSTER 31 CAMBRIDGE VILLAGE, BRGY. SAN ANDRES CAINTA, RIZAL, AK - 1800 | For Doctor's Approval |
| 40 |
3cf62a547f12b014d067428f49b418931724810979
08/27/2024 10:11 |
gardenia-rx.com | JAY R MAGDALUYO TEST GARDENIA | 6M CLUSTER 31 CAMBRIDGE VILLAGE, BRGY. SAN ANDRES CAINTA, RIZAL, AK - 1800 | For Doctor's Approval |
| 41 |
e67687cd07ddc608a89dc0433fbeb3f41724773663
08/27/2024 11:52 |
gardenia-rx.com | test test | 18000 portofino circle Palm Beach Gardens, FL - 33418 | For Doctor's Approval |
| 42 |
2de728e99e2b5d5bfddff2284b971c321724082584
08/19/2024 11:50 |
thinnex.com | Dimitry Prophete | 1800 North Field Street Building 1, Unit 3509 Dallas, TX - 75202 | For Doctor's Approval |
| 43 |
f3bdd86afcee763cd780d4a6e60a87451724005337
08/18/2024 02:23 |
theurbanyou.com | Test Test | 1309 Coffeen Avenue STE 1200 Sheridan, WY - 82801 | For Doctor's Approval |
| 44 |
45f960efb036ae246bf2ee56fee929c91724004869
08/18/2024 02:15 |
theurbanyou.com | test Test | 4705 S adelle circle MESA, AZ - 85212 | For Doctor's Approval |
| 45 |
3d88e6e46a76a0944a1b2297d9cf558f1724003148
08/18/2024 01:46 |
alexandriacompounding.com | test Test | 1309 Coffeen Avenue STE 4070 MESA, AZ - 85212 | For Doctor's Approval |
| 46 |
832cc51d6ea014b22cdb359f714e87b01723578691
08/13/2024 03:52 |
gardenia-rx.com | TEST TEST | 18000 PORTOFINO CIRCLE palm beach gardens, FL - 33418 | For Doctor's Approval |
| 47 |
832cc51d6ea014b22cdb359f714e87b01723575319
08/13/2024 03:03 |
gardenia-rx.com | TEST TEST | 18000 PORTOFINO CIRCLE palm beach gardens, FL - 33418 | For Doctor's Approval |
| 48 |
b108417c38155222bf0d14cbb48c71231723483272
08/12/2024 01:21 |
thinnex.com | Test Test | 4705 S adelle circle MESA, AZ - 85212 | For Doctor's Approval |
| 49 |
b108417c38155222bf0d14cbb48c71231723482106
08/12/2024 01:02 |
thinnex.com | Test test | 4705 S adelle circle MESA, AZ - 85212 | For Doctor's Approval |
| 50 |
b108417c38155222bf0d14cbb48c71231723090715
08/08/2024 12:19 |
thinnex.com | Test Patient | 4705 S adelle circle MESA, AZ - 85212 | For Doctor's Approval |
| 51 |
b108417c38155222bf0d14cbb48c71231723090563
08/08/2024 12:16 |
thinnex.com | test two | 1234 S adelle circle MESA, AZ - 85212 | For Doctor's Approval |
| 52 |
cf2c38b45180395899862828f5560ac31723090099
08/08/2024 12:10 |
thinnex.com | test test | 4705 S Adelle Cir Mesa, AZ - 85212 | For Doctor's Approval |
| 53 |
0398b4821e075b96bcd5918b00eb43e81723087776
08/07/2024 11:30 |
thinnex.com | Test Test Thinnex | Test Test Test, AK - Test | For Doctor's Approval |
| 54 |
b108417c38155222bf0d14cbb48c71231723057327
08/07/2024 03:03 |
thinnex.com | Test Test | 4705 S adelle circle MESA, AZ - 85212 | For Doctor's Approval |
| 55 |
b108417c38155222bf0d14cbb48c71231723057194
08/07/2024 03:00 |
thinnex.com | test test | 4705 S adelle circle MESA, AZ - 85212 | For Doctor's Approval |
| 56 |
0398b4821e075b96bcd5918b00eb43e81722916996
08/06/2024 12:06 |
thinnex.com | jayr test thinnex 2 | Test Test test, AK - 5611 | For Doctor's Approval |
| 57 |
fdbdaa9540999c52cae899416d1898da1722911144
08/05/2024 10:27 |
thinnex.com | JAY R MAGDALUYO THINNEX TEST | 6M CLUSTER 31 CAMBRIDGE VILLAGE, BRGY. SAN ANDRES CAINTA, RIZAL, AK - 1800 | For Doctor's Approval |
| 58 |
8667104ab377e9242570a7e77acac8381722358007
07/30/2024 12:47 |
DemoAcccount.com | test test | 4705 S adelle circle MESA, AZ - 85212 | For Doctor's Approval |
| 59 |
0052212b096a02f3b2be3c63853142ff1722348260
07/30/2024 10:05 |
Thinnex.com | Test Test | 4705 S adelle circle MESA, AZ - 85212 | For Doctor's Approval |
| 60 |
0052212b096a02f3b2be3c63853142ff1722347273
07/30/2024 09:49 |
Thinnex.com | Test Test | 4705 S adelle circle MESA, AZ - 85212 | For Doctor's Approval |
| 61 |
3e9c4e28e7f297a37545f21566620fa71722332363
07/30/2024 05:41 |
gardenia-rx.com | JAY R TEST AUTH 1 | 6M CLUSTER 31 CAMBRIDGE VILLAGE, BRGY. SAN ANDRES CAINTA, RIZAL, AK - 1800 | For Doctor's Approval |
| 62 |
1721736923
07/23/2024 08:16 |
body4ever.com | Test Test | 4705 S Adelle Circle Mesa, AZ - 85212 | For Doctor's Approval |
| 63 |
b05dc90125b268f1f8ba8edb5168ad221720838753
07/12/2024 10:46 |
gomymeds.com | Test test | 4705 S adelle circle MESA, AZ - 85212 | For Doctor's Approval |
| 64 |
1720543680
07/09/2024 12:51 |
body4ever.com | Amy Bjork | 133 Pineneedle Dr Bradenton, FL - 34210 | For Doctor's Approval |
| 65 |
f77342dc801ace6aad122bd5c653b1f61719966509
07/02/2024 08:32 |
gomymeds.com | Daniel Bonder | 2721 NE 8th terrace Pompano beach, FL - 33064 | For Doctor's Approval |
| 66 |
c1e031fd98f3273073a7155e35524fbb1719349398
06/25/2024 05:04 |
nrish.com | TEST TEST | 2813 N 29TH PL Phoenix, AZ - 85008 | For Doctor's Approval |
| 67 |
64e6b757ed758cb3e00e6ad75f75d8501718309281
06/13/2024 04:08 |
DemoAcccount.com | test test | 116 w geneva dr tempe, AZ - 85281 | For Doctor's Approval |
| # | Products | SKU | Title | Qty | Price |
|---|
| Patient Name (First, Last) |
SEX |
|
||||
| DOB | Cell Phone | |||||
| Address | ||||||
| Required Patient Information (Fill out or attach demographics with fax) | |
| Allergies (if none, must write none) |
|
| Current Medications (if none, must write none) |
|
| Driver’s License # | |
RX |
||||||||||||||||||
|
| Facility Name | Facility Phone | ||
| Facility Address | |||
* If Provider is a NP/PA a Supervising Provider is required for a Controlled Substance (or a Standing Order must be on file) *
| Doctor Name Goes Here | |
|---|---|
| Docotors' Notes Content Here | Edit |
| # | Order # | Card No. | Amount | Discount Code Type Amount |
Invoice | Invoice Created |
Is Paid | Is Refunded | Payment Status |
|---|
| # | Order # | Prescription Order No. |
Name | Medication | Refill No | Days Supply | Refills | Order Status |
Canceled At |
Tracking No. |
Shipping Provider |
Date Delivered |
|---|
| Patient Name (First, Last) |
SEX |
|
||||
| DOB | Cell Phone | |||||
| Address | ||||||
| Required Patient Information (Fill out or attach demographics with fax) | |
| Allergies (if none, must write none) |
|
| Current Medications (if none, must write none) |
|
| Driver’s License # | |
|
|
|
| Facility Name | Facility Phone | ||
| Facility Address | |||
* If Provider is a NP/PA a Supervising Provider is required for a Controlled Substance (or a Standing Order must be on file) *