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Transfer Medication to Lathams Pharmacy
REQUEST FOR TRANSFER TO LATHAMS PHARMACY
Patient Details: Tell us about you so that we can verify who you are with your old pharmacy
Birth Date MM/DD/YYYY
Your Phone Number 256 - ### - ####
Notes for Pharmacy (Optional)
Previous Pharmacy
Previous Pharmacy Phone
Transfer all of my medications
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Address
178 S Main St,
Arab, AL 35016
Phone: 256-586-4132
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