Park View


Parkview Compounding	1-800-605-0166
Pharmacy

Welcome To Parkview Compounding Pharmacy -- PCAB Accredited for your Health and Wellness -- We Carry Professional Grade Nutraceuticals, Vitamins, Minerals at Wholesale Prices! -- Experts in Natural Hormone Therapies

Contact Us

Phone: 800 - 605 - 0166
Fax: 866 - 895 - 8571
Email: louis@parkviewrx.com

Address:
Parkview Compounding Pharmacy
8283 Grove Avenue Ste105
Rancho Cucamonga, CA
91730
Between Foothill & Arrow Hwy

Please Fill This Form Send us Or Download Here.

New RX Transfer RX Refill RX

1- Patient Information

Name:
Date of birth:
Home Phone:
Work Phone:
Address:
City:
State:
Zip:
Allergies:
Phone number where you can be reached:

2 - Refill/Retrieval Method

Please Check of the following:
Please Use AUTO-FILL (Healthminder) for my prescriptions
I will generally pick up my prescriptions
Please deliver (some one must be available to sign for the medication)
Please Ship/Mail (some one must be available to sign for the medication)

Delivery address (if diffrent from above):

Address:
City:
State:
Zip:
Phone:

3- Insurance Information
Please fax a copy of insurance card, (If Available)

Insurance Company :
Social Security Number:
PCN#/ BIN#:
Group ID#:
ID /Member#:

4- Billing Information
Type of credit card VISA MC DISCOVER AMEX

Name (As it appear on card):
Code#:
Credit Card#:
Group ID#:
Expiry Date:
I authorize all the perscriptions charged by my insurance plan to be billed to the above charge card number.
Security code :

Parkview Compounding Pharmacy
8283 Grove Ave., Ste. 105/107 Rancho Cucamonga, CA 91730 Phone: 800-605-0166 / 909-981-0956 Fax: 909-981-8409 / 866-895-8571

Parkview Pharmacy and Home Healthcare only accepts original prescriptions that are based on a face to face medical consultation between a patient and their physician (except
where expressly permitted by law)

We are Proud to be affiliated with the following Professional Organizations