Welcome to Portage Pharmacy

To order by phone 24 hours a day call (269) 327-0033 or 800-689-1823.
Leave a message on our 24-hour voice mail system. When phoning your refill in please have your prescription number available and let us know when you would like to pick up your prescription.

To order by fax 24 hours a day dial (269) 327-2709.
Patients may send refill requests via fax. Please provide in writing the information requested below. We recommend completing the form online and printing the results to ensure all necessary information is included.

Please fill out the form below to request a refill of your current prescription or supplements.
* indicates a required field

* First Name:

* Last Name:

* Date of Birth:

/ /

* Address:

* City:

* State:

* Zip:

* Daytime Phone:

( )

* Email:

Prescriptions:

1. Prescription Number:

Qty:

2. Prescription Number:

Qty:

3. Prescription Number:

Qty:

4. Prescription Number:

Qty:

5. Prescription Number:

Qty:

Supplements:

1. Supplement:

Strength: Qty:

2. Supplement:

Strength: Qty:

3. Supplement:

Strength: Qty:

4. Supplement:

Strength: Qty:

5. Supplement:

Strength: Qty:

* Shipping:

We will process your order within a 24 hour business day.

Is your credit card on file with us? YES NO

PICK UP SHIPPING

Date picking up:

Time picking up: :

Comments:

* Security Code:

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7966 Lovers Lane - Portage, MI 49002 - 800-689-1823 - FAX: 269-327-2709