Now Offering Moderna, JJ, Pfizer Bivalent Vaccines for Adults & Kids 5 and Older

New Prescriptions

New Prescriptions

We would love the opportunity to serve as your trusted prescription provider.
Please fill out the form below and we will take it from here!

You must bring original prescription with you when you come to pickup.

Pharmacy Location

First Name

Last Name

Email Address

Phone Number

Birth Date (XX/XX/XXXX)

Provider Name

Provider Phone Number

Medication Name

Strength / Quantity

Medication Name

Strength / Quantity

Medication Name

Strength / Quantity

Medication Name

Strength / Quantity

Message to Pharmacist

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Pacific Medical Pharmacy #1
1101 North Pacific Ave , Suite 101, Glendale, CA 91202
(818) 548-1330 - (818) 548-3590

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Pacific Medical Pharmacy #2
808 East California Avenue, Glendale, CA 91206
(818) 696-2213 - (818) 696-2214

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Pacific Medical Pharmacy #3
6624 Foothill Boulevard, Tujunga, CA 91042
(818) 875-4053 - (818) 875-4063

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