Medicine Shoppe #0099
1170 Perkiomen Ave
Reading, PA, 19602
Tel.: (610) 378-1396
Fax.: (610) 378-5529
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