Richlands Pharmacy

Richlands, VA

Refill a Prescription

Please complete this form to refill a prescription already on file.

First Name *

Last Name *

Phone *

Email *

Date of birth *

Preferred Delivery Method *

I will pick it up at the pharmacy

Please mail my prescription

Would you like us to provide a Personalized Nutrition Depletion & Supplements Consultation? *

Yes, please call me.

Yes, please email me.

No thanks.

Many medications affect key nutrients in your body, so it’s important to take the right supplements to replace them. Our pharmacists are happy to e-mail or call you with details on what supplements you should be taking with your medication to enhance health and minimize side effects.

Names of Medications *

Prescription Number(s)*

Okay to Charge Card on File? *

Yes

No, please contact me for a new payment.

Contact Us

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