Medicine Shoppe #1427
760 Paulding Plaza
Dallas, GA, 30132
Tel.: (770) 445-6422
Fax.: (770) 443-0180
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.

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Rx Number(s)

Numbers only
NO letters or dashes