Medicine Shoppe #2006
625 South Duke Street
Lancaster, PA, 17602
Tel.: (717) 208-3415
Fax.: (717) 435-9842
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