Brewerton Pharmacy, Gift Shop and Compounding Center

Brewerton Pharmacy	Village Pharmacy	Village Pharmacy
9679 Brewerton Road	537 South Main Street	792 North Main Street
Brewerton, New York 13029	Central Square, New York 13036	North Syracuse, New York 13212
Phone: (315) 676-4441	Phone: (315) 668-2659	Phone: (315) 458-0500
Fax: (315) 676-5255	Fax: (315) 676-5256	Fax: (315) 458-8455

Prescription Refills

Please fill out the following form and click the submit button to send your refill order to us.
Your prescription will be ready within the next few hours unless we notify you differently.

Patients First Name:
Patients Last Name:
Phone Number:
E-mail Address:
Refill Number 1
Refill Number 2
Refill Number 3
Refill Number 4

Please check the location where your prescription was last filled:
	Brewerton Pharmacy 9679 Brewerton Road Brewerton, New York 13029	Village Pharmacy 537 South Main Street Central Square, New York 13036	Village Pharmacy 792 North Main Street North Syracuse, New York 13212

Please check which location you would like to pickup your refill from:
	Brewerton Pharmacy 9679 Brewerton Road Brewerton, New York 13029	Village Pharmacy 537 South Main Street Central Square, New York 13036	Village Pharmacy 792 North Main Street North Syracuse, New York 13212

Pick-Up Time Please select a date and time to pick up your medicine. Allow at least three hours for your prescription to be filled.
Date:	Time:	AM	PM

Delivery Options

You can choose to have your prescription delivered to your home OR if you are out of the area, you can choose to have your prescription mailed to you.

I would like to have my prescription delivered.

Please mail my prescription to the following address:

Street:
City:		State:		Zip: