Prescription Request

Prescription Request

Patient Information
Prescription #1
(In mgs/mls)
Pharmacy Information
Please tell us which pharmacy you would like us to call your prescription into. Please be precise as there are many pharmacies and pharmacy locations.:

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WHAT'S GOING AROUND? VISUAL SYMPTOM CHECKER
425 Tioga Avenue | Kingston, PA 18704 | Phone: 570-288-6543
1081 Oak Street | Pittston, PA 18640 | Phone: 570-602-PAKP
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