Prescription Refills
Please enter all required data below and click Submit to send us your refill request.

All fields marked with a * are required:

Medications
Enter your Rx Number(s) in the box(es) below. Do not include the "C" on controlled substances.

  Rx Number Qty
1.
2.
3.
2.
4.
6.

Patient Data
Please type names as they appear on the label.

First Name*
Last Name*
Email
Birth Date*
Phone*

Shipping Data
Please select a shipping method below.
Note: Refrigerated medications must and will be sent overnight.

Pick Up
UPS $6.95
UPS Overnight - Call for Pricing

If picking up, please indictate date and time preference, allowing 2 days advance notice on all prescription refills.

Company Name
Address 1*
Address 2
City*
State*
Zip*

Payment method on file
(If payment method is not on file with Pensacola Apothecary, please call the pharmacy at 850-473-9190.)

Other

Special Instructions

If any addition supplements are needed please list them. Include supplement name, bottle size and quantity.

 
Additional Supplements

Note: Please allow two days advance notice on prescription refills.