MIDLAND PHARMACY
606 MIDLAND AVE
STATEN ISLAND, NY 10306
718-351-1689
1-888-249-6625		  

PILL BOTTLE.gif (1694 bytes) NEW PRESCRIPTONS & TRANSFERS
Send us your valid medical prescriptions and we will get them to you without you ever leaving your home. The product will be shipped direct to your doorstep.
 
 
ORDER RIGHT FROM YOUR BED!

FAX YOUR NEW SCRIPT TO US AT 1-718-980-6803
AND FILL OUT THE FOLLOWING FORM FOR US ALSO.
 
     

NAME

ADDRESS

CITY  STATEZIP CODE

COUNTRY

PHONE

E-MAIL

 

PRESCRIPTIONSRX# 
PRESCRIPTIONSRX#
PRESCRIPTIONSRX#
    
DOCTOR REFILL AUTHORIZATION:
                   PHARMACY TRANSFERING FROM
                   PHARMACY PHONE #
I wish to have my prescriptions transferred from my present pharmacy to MIDLAND PHARMACY.
 
If no refills remaining here is my doctor's information for you to contact:
DOCTOR
DOCTOR PHONE
 
ALLERGIES/MEDICAL CONDITIONS: