E-Prescribing is now mandatory in the state of New York. In order to comply with state regulations, and to improve our ability to communicate with your pharmacy, please:
* Print this form and bring it completed to your first visit.
* Print it and update it as your preferred pharmacy information changes.
* Include your pharmacy name, street address, zip code and phone number.
* Please mail or fax us this information at (212) 535-3956.
* Include any alternative pharmacy phone number(s) and any mail order pharmacy information.