Medicine Shoppe #1291
725 W Ingomar Rd
Ingomar, PA, 15127
Tel.: (412) 367-5778
Fax.: (412) 367-0144
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