Senior/Nursing Home | Kennedy Road I.D.A.

Kennedy Road I.D.A. Pharmacy | 4-2 Antrim Cr., Scarborough, ON | Tel: 416-298-2222 | Fax: 416-298-2223

Senior/Nursing Home Refill Prescription Request

Home Name & Room # & Phone #:

Patient Name:

Rx Refill Numbers / Drug Names:

Pickup or Delivery?

Pickup
Delivery

Special Instructions: