Transfer a Prescription

Name: Floral Park Chemists
Address: 282 Jericho Tpke, Floral Park, NY, 11001, US
Telephone: 516-502-1152

Fill out the form below to request a prescription transfer.

Need Help? Call us for immediate assistance at 516-502-1152.

"*" indicates required fields

Please provide the information we'll need to verify who you are with your old pharmacy.

Name*

First Last

Phone

Email*

Birthday*

Please provide information about your old pharmacy.

Old Pharmacy Name*

Pharmacy Phone*

Pharmacy Address*

Street Address Address Line 2 City State ZIP Code

Transferring to:

Please provide information about your prescriptions you'd like to transfer

Transfer all Prescriptions?*

Yes

Prescriptions to Transfer:*

Medication Name

RX Number

Notes for Pharmacy

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