Medicine Shoppe #0362
102 East Atlantic Ave
Franklin, PA, 16323
Tel.: (814) 437-9115
Fax.: (814) 437-1263
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