Medicine Shoppe #1958
412 East Commons, Ste 110
Pittsburgh, PA, 15212
Tel.: (412) 442-1925
Fax.: (412) 442-1940
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