Medicine Shoppe #1758
296 Bedford Street
Stamford, CT, 06901
Tel.: (203) 327-4479
Fax.: (203) 975-0427
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