Transfer RX Prescription You are welcome to transfer your Rx to Nick’s Drugs Store. Please complete the form here to proceed. PATIENT DETAILS Name First Last Date of Birth* Phone Number* Address* State* Zipcode* Pharmacy Name* Phone Number* PRESCRIPTIONS TO BE TRANSFERED If you would like to transfer all prescriptions, simply check the box below. If you would like to selectively transfer your prescriptions, simply fill out the form below. Transfer all of my prescriptions. Medication Name Current Pharmacy Number Please type the characters* This helps us prevent spam, thank you. Send This field should be left blank
