Medicine Shoppe #1993
47 Stewart Avenue
Roscoe, NY, 12776
Tel.: (607) 498-4111
Fax.: (607) 498-4117
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