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FM HERBAL PHARMACY PRESCRIPTION ONLINE ORDERING

Order your prescription refills below now.

Need to transfer your prescription? Click Here: Prescription Transfer Form

Complete the form below and click the "Submit" button. * Indicates required field.

Prescription Refill

Patient Information

Prescription # and Name  *
First Name  *
Last Name  *
Phone  *
Birth Date  *

Billing Information

Type of payment *
Delivery Method * Pick up at store    Deliver    Mail Refill

Best way to contact you:

Home
Cell    

Special Instructions

F.M. Herbal RX Prescriptions

Transfer your prescriptions below now.

Just need a refill? Click Here: Prescription Refill Form

Complete the form below and click the "Submit" button. * Indicates required field.

Transfer From Pharmacy

Pharmacy Name  *
Pharmacy Phone  *

Transferring to Flower Mound Pharmacy

Patient Information

Prescription # and Name  *
Known Allergies  *
First Name  *
Last Name  *
Address  *
 
City  *    Zipcode  *
Birth Date  *
Phone  *
Insurance Company Name
Plan/Group Name
Group Number
Primary Policy ID
Bin#
Primary Policy Holder's First Name
Primary Policy Holder's Last Name
Patient's Relationship to Primary Policy Holder

Billing Information

Type of payment *
Delivery Method * Pick up at store    Deliver    Mail Refill

Best way to contact you:

Home
Cell    

Special Instructions

Pharmacy   972-355-4614   [email protected]
 Specialty Foods 972-956-9334  [email protected]
1001 Cross Timbers Rd # 1170   Flower Mound, TX 75028

We are a Lewisville area pharmacy. Compounding Pharmacy near Coppell. Lewisville Gluten Free Foods provider.

 

 


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Pharmacy   972-355-4614   fmherbalrx@aol.com
 Specialty Foods 972-956-9334  fmspecialtyfoods@sbcglobal.net 
1001 Cross Timbers Rd # 1170   Flower Mound, TX 75028