Medicine Shoppe #1873
105 Wheatfield Drive, Ste 2
Milford, PA, 18337
Tel.: (570) 296-5138
Fax.: (570) 296-5386
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