Located on the Corner of Your World, 5201 Chippewa, St. Louis, MO

HOME | ABOUT US | ORDER REFILLS | CONTACT US

   To order your refills on-line, simply fill out the form below and press the Submit button. Please include all information. If you would like for us to deliver your refill, please check the box and let us know the best time. If your label shows “No Refills,” we will be glad to call your doctor but please check the box “Would you like us to call your doctor?” If you have more than four (4) refills, please place other numbers in the “Comment” box.
   If your request is received by 12 Noon we will have your prescription ready by the close of business. If received after that time, it will be ready the next day. If you would like to be notified by email that your prescription is ready, please check that box. If you would like us to call, please check that box.


Keller Apothecary Refill Order Form
* First Name
* Last Name
* Address
* A phone number where you can be reached.
* Email Address
Refill 1 Rx number
Refill 2 Rx number
Refill 3 Rx number
Refill 4 Rx number
Would you like us to deliver your Rx? Yes No
What is the best time?
Would you like us to call your doctor for a refill. Yes No
Please call me when my Rx is ready. Yes No
Any questions or comments?
* Indicates Response Required



This form created at http://www.formsite.com/

Password Protect Web Content


 

If you have any problems, please call us at 314-352-5201.

STORE HOURS
9 a.m.-6 p.m. Mon., Tue., Thur., Fri.
9 a.m. to 5 p.m. Wed.
9 a.m. - 1 p.m. Sat

HOME | ABOUT US | ORDER REFILLS | CONTACT US