Medicine Shoppe #0533
240 W Main Street
Brookville, PA, 15825
Tel.: (814) 849-5217
Fax.: (814) 849-4373
Request a refill for your medication(s)
Please note that this form allows you to submit up to 5 prescriptions for refill. If you would like to submit more than 5 prescriptions for refill, please complete additional submission forms.


Rx Number(s)

Numbers only
NO letters or dashes