Prescription Refills Online

To refill prescription(s) online, simply complete the Refill Request form below (e-mail address is optional).
* INDICATES REQUIRED FIELD

* First Name: * Last Name:
* Phone Number: ( )
* E-mail Address:
Please enter the prescription number(s) from your prescription label (see sample below)
* Prescription #1
  Prescription #2
  Prescription #3
  Prescription #4
  Prescription #5
  Prescription #6
  Prescription #7
  Prescription #8
* Would you like the pharmacy to contact your doctor if your prescription needs authorization?
Yes    No

* Would you like to:
   Pickup your prescription
   Have your prescription mailed to you
   Have your prescription delivered to you
Unity Pharmacy
126-4 E Main St Islip, NY 11730
Fax: (631) 581-9410
Phone: (631) 581-9620