Refill Request

Patient Name(Required)

First Last

Prescription Number(s)(Required)

Enter your prescription number below. To enter additional prescriptions, click the plus sign to the right of the field.

Phone(Required)

Pick Up or Mail(Required)

I will pick up my prescription.

Please mail my prescription to the address on file.

Special Instructions

Please DO NOT include HIPAA-related information.

Coastal Pharmacy & Wellness
29 Marginal Way, Suite 4
Portland, ME 04101
Pharmacy: (207) 899-0886
Wellness Department: (207) 899-0993
Fax: (207) 899-0826

HOURS

Pharmacy

Monday-Friday 9:00 am-6:00 pm
Saturday 9:00 am-noon

Store

Monday-Friday 9:00 am-6:00 pm
Saturday 9:00 am-5:00 pm

Coastal Pharmacy & Wellness

Free parking is available in Coastal designated spots next to the building or anywhere in the rear parking lot.

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