Albany Apothecary - Prescriptions

This form is for submitting requests for refills online. Please complete this form providing your name, address, phone number, email address and prescription number(s). Without this information we cannot process your order. You can also include any questions or requests that you may have. Click on submit and your order will be sent to us. Please allow at least 24 hours for your refill.

Name:	*
Address:	*
City:	*
State:	*
Zip Code:	*
Email Address:	*
Daytime Phone:	*
Evening Phone:	*
Contact Method:	*
RX1 #	*
RX2 #
RX3 #
RX4 #
RX5 #
RX6 #
If you have any questions or special requests, please bring them to our attention here.

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