STAUFFERS PHARMACY

Pharmacy Hours:
Monday thru Friday - 9am to 7pm
Saturday - 9am to 5pm
Closed Sunday

TO REFILL YOUR EXISTING PRESCRIPTION ONLINE, PLEASE FILL OUT THE FORM BELOW.


Bold Fields Are Required To Submit This Form.

Your information will be kept confidential, and will not be sold or given to any third party.

Name
Phone Number
E-Mail
Prescription Number(s):
Prescription #1.
Prescription #2.
Prescription #3.
Prescription #4.
Prescription #5.
Prescription #6.
Prescription #7.
Prescription #8.
Prescription #9.
Prescription #10.
Pick Up Date
Comments
 


© 2008 Stauffers of Kissel Hill. All rights reserved.