Medicine Shoppe #0146
709 Ligonier Street
Latrobe, PA, 15650
Tel.: (724) 539-4565
Fax.: (724) 539-3653
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.

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Rx Number(s)

Numbers only
NO letters or dashes