Doctors Pharmacy
18801 E. Ten Mile Rd.
Roseville, MI, 48066
Tel.: (586) 777-2190
Fax.: (586) 777-5847
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