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Home
About
Patients
Prescribers
Products
Contact
Home
About
Patients
Prescribers
Products
Contact
277 Brighton Beach Ave, Brooklyn, NY 11235 | 718-332-8428 |
info@brightonrx.com
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TRANSFERS
READY TO TRANSFER YOUR PRESCRIPTIONS?
SIMPLY text the word
TRANSFER
to 718-332-8428 and we will handle the rest.
Or
Fill out the form below with the prescriptions you'd like to TRANSFER and we'll update you when they are ready.
*Full Name:
*Date of Birth:
*Email Address:
*Mobile Phone:
*Pharmacy Name:
*Pharmacy Address:
*Pharmacy Phone:
Attach a picture of your prescription label OR you can fill out the info below.
Rx# or Drug:
Rx# or Drug:
Rx# or Drug:
Rx# or Drug:
How would you like to recieve your medication?
Pickup
Delivery
Address:
City :
Zip:
State:
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