Refill My Prescription
Phone: (715) 723-9192
*
First Name:
*
Last Name:
*
Phone Number:
(
)
*
E-mail Address:
Please enter the prescription number(s) from your prescription label
*
Prescription #1
Prescription #2
Prescription #3
Prescription #4
Prescription #5
Prescription #6
Prescription #7
Prescription #8
*
Would you like the pharmacy to contact your doctor if your prescription needs authorization?
Yes
No
*
Would you like to:
Pickup your prescription
Have your prescription mailed to you
Have your prescription delivered to you
Medicine Shoppe 270
603 North Bridge Street
Chippewa Falls, WI 54729
Fax: (715) 723-6463