Botox is an RX required item. You can only purchase it via Allergan directly, and to purchase it you must have a valid NPI. Also administering botox requires a diagnosis, even for cosmetic reasons. My aunt is a DNP who owns her own med spa in Portland, OR - I work for her as needed, and process her paperwork, administer botox. Some steps may vary depending on state, but it is an RX required item and requires a diagnosis, even for "off label" use such as fine lines / wrinkles - as the company uses the procedure codes to track incidentals of side effects, adverse reactions.