Transfer Your Prescriptions Complete our form below to become a new customer. Need Help? Call us for immediate assistance 516-277-2668. Fax 516 277-2671Name(Required) First Last Phone(Required)Email(Required) Date of Birth MM slash DD slash YYYY Do you have any allergies?Previous Pharmacy NamePrevious Pharmacy Phone NumberPrevious Pharmacy Address Street Address Address Line 2 City State NYAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Transfer All Prescriptions? Yes, please transfer all of my prescriptions Medication # or NamePlease list your medications you would like transferred Add RemoveYour messagePhoneThis field is for validation purposes and should be left unchanged. Δ
