The following form is only for refills, if you are requesting a new prescription you must call the pharmacy.

FedEx prices vary from state to state. Please call Pharmacy to verify your options.

Please fill in the following information.

* Indicates required field

Refill Request

Refill Details

Prescription Number (Six Digit) *

Amount of Refills remaining *

How many days supply would you like *

How would you like to receive your prescription *

Refill #1

Refill #2

Refill #3

Refill #4


Toll Free: 800-553-7429
Local: 561-218-0111

160 SW 12th Ave suite 102
Deerfield Beach, Fl 33442

Information contained on this site is provided as an informational aide and for reference use only. The content herein is not intended to be, act as, or replace medical advice or diagnosis for individual health conditions nor is it making evaluations as to the risks or benefits of particular preparations. Please consult a licensed healthcare professional or veterinarian about diagnosis and treatment. Information and statements on this site have not been evaluated by the Food and Drug Administration.

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