Medicine Shoppe #1278
5020 Centre Avenue
Pittsburgh, PA, 15213
Tel.: (412) 586-5410
Fax.: (412) 586-5351
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