Prescription Refills

You can order refills for existing prescriptions using our form on this page. If you are a returning patient, simply enter your prescription information by selecting the pharmacy below.

Choose Your Pharmacy

Prescription Refill(s): De Blieck's
Enter Your Personal Information
First Name *
Last Name *
Email *
Phone * (Just numbers. No dashes, dots or parentheses please.)
Select Your Prescriptions
- Patient Name *
- Rx No
- Med. Name
- [ADD MORE]
Pick-Up or Delivery
Please Select:
Pick-Up: or Delivery:
- PICKUP:
  Prescriptions are usually available for pickup 2 hours after submission of this form. Thus your order should be ready by the approximately time listed below provided the prescription are valid refills and the medication is in stock. For urgent requests please call the store directly.
  Availability: After 1pm*
  *Please note the store hours listed here. Orders are not available after hours. In this case, they will be available the next business day.
- STORE HOURS:
  
  Mon: 9AM – 8PM
  Tues: 9AM – 8PM
  Wed: 9AM – 8PM
  Thurs: 9AM – 8PM
  Friday: 9AM – 7PM
  Saturday: 9AM – 5PM
  Sunday CLOSED
  
  STORE ADDRESS:
  
  467 High Mountain Road
  North Haledon, NJ 07508
  Tel: (973) 427-6300
  Fax: (973) 427-7579
- DELIVERY:
  Prescriptions will be delivered within 2-6 hours after submission of this form. If the form is submitted within 2 hours of closing or overnight, delivery will be scheduled for the next business day. For urgent requests please call the store directly. Please indicate in the notes section below what day/time you plan to pick up your medication so we can ensure it is ready for you.
  
  *Please note the store hours listed here. Delivery service is available after the following times until close of business for the following stores.
  
  Sicomac Pharmacy: Delivery available after 11am
  DeBlieck's Pharmacy: Delivery available after 11am
  Ho-Ho-Kus Pharmacy: Delivery Available after 12 noon.
  Burgio's Pharmacy: Delivery Available after 3pm, Mon-Fri.
  
  Any questions, please contact your local pharmacy staff. Thank you!
- STORE HOURS:
  
  Mon: 9AM – 8PM
  Tues: 9AM – 8PM
  Wed: 9AM – 8PM
  Thurs: 9AM – 8PM
  Friday: 9AM – 7PM
  Saturday: 9AM – 5PM
  Sunday CLOSED
  
  STORE ADDRESS:
  
  467 High Mountain Road
  North Haledon, NJ 07508
  Tel: (973) 427-6300
  Fax: (973) 427-7579
Full Address Required For Delivery *
Final Comments
Additional items, Comments Or Changes:
Should be Empty:

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Prescription Refill(s): Ho-Ho-Kus
Enter Your Personal Information
First Name *
Last Name *
Email *
Phone * (Just numbers. No dashes, dots or parentheses please.)
Select Your Prescriptions
- Patient Name *
- Rx No
- Med. Name
- [ADD MORE]
Pick-Up or Delivery
Please Select:
Pick-Up: or Delivery:
- PICKUP:
  Prescriptions are usually available for pickup 2 hours after submission of this form. Thus your order should be ready by the approximately time listed below provided the prescription are valid refills and the medication is in stock. For urgent requests please call the store directly.
  Availability: After 1pm*
  *Please note the store hours listed here. Orders are not available after hours. In this case, they will be available the next business day.
- STORE HOURS:
  
  Mon: 9AM – 7:30PM
  Tues: 9AM – 7PM
  Wed: 9AM – 7PM
  Thurs: 9AM – 7PM
  Friday: 9AM – 7PM
  Saturday: 9AM – 4PM
  Sunday CLOSED
  
  STORE ADDRESS:
  
  622 North Maple Avenue
  Ho-Ho-Kus, NJ 07423
  Tel: (201) 444-2026
  Fax: (201) 612-8182
- DELIVERY:
  Prescriptions will be delivered within 2-6 hours after submission of this form. If the form is submitted within 2 hours of closing or overnight, delivery will be scheduled for the next business day. For urgent requests please call the store directly. Please indicate in the notes section below what day/time you plan to pick up your medication so we can ensure it is ready for you.
  
  *Please note the store hours listed here. Delivery service is available after the following times until close of business for the following stores.
  
  Sicomac Pharmacy: Delivery available after 11am
  DeBlieck's Pharmacy: Delivery available after 11am
  Ho-Ho-Kus Pharmacy: Delivery Available after 12 noon.
  Burgio's Pharmacy: Delivery Available after 3pm, Mon-Fri.
  
  Any questions, please contact your local pharmacy staff. Thank you!
- STORE HOURS:
  
  Mon: 9AM – 7:30PM
  Tues: 9AM – 7PM
  Wed: 9AM – 7PM
  Thurs: 9AM – 7PM
  Friday: 9AM – 7PM
  Saturday: 9AM – 4PM
  Sunday CLOSED
  
  STORE ADDRESS:
  
  622 North Maple Avenue
  Ho-Ho-Kus, NJ 07423
  Tel: (201) 444-2026
  Fax: (201) 612-8182
Full Address Required For Delivery *
Final Comments
Additional items, Comments Or Changes:
Should be Empty:

February 2016
31	1	2	3	4	5	6
7	8	9	10	11	12	13
14	15	16	17	18	19	20
21	22	23	24	25	26	27
28	29	1	2	3	4	5
6	7	8	9	10	11	12
13	14	15	16	17	18	19

Prescription Refill(s): Sicomac
Enter Your Personal Information
First Name *
Last Name *
Email *
Phone * (Just numbers. No dashes, dots or parentheses please.)
Select Your Prescriptions
- Patient Name *
- Rx No
- Med. Name
- [ADD MORE]
Pick-Up or Delivery
Please Select:
Pick-Up: or Delivery:
- PICKUP:
  Prescriptions are usually available for pickup 2 hours after submission of this form. Thus your order should be ready by the approximately time listed below provided the prescription are valid refills and the medication is in stock. For urgent requests please call the store directly.
  Availability: After 1pm*
  *Please note the store hours listed here. Orders are not available after hours. In this case, they will be available the next business day.
- STORE HOURS:
  
  Mon: 9AM – 8PM
  Tues: 9AM – 8PM
  Wed: 9AM – 8PM
  Thurs: 9AM – 8PM
  Friday: 9AM – 7PM
  Saturday: 9AM – 4PM
  Sunday CLOSED
  
  STORE ADDRESS:
  
  300 Sicomac Avenue
  Wyckoff, NJ 07481
  Tel: (201) 891-0822
  Fax: (201) 891-4790
- DELIVERY:
  Prescriptions will be delivered within 2-6 hours after submission of this form. If the form is submitted within 2 hours of closing or overnight, delivery will be scheduled for the next business day. For urgent requests please call the store directly. Please indicate in the notes section below what day/time you plan to pick up your medication so we can ensure it is ready for you.
  
  *Please note the store hours listed here. Delivery service is available after the following times until close of business for the following stores.
  
  Sicomac Pharmacy: Delivery available after 11am
  DeBlieck's Pharmacy: Delivery available after 11am
  Ho-Ho-Kus Pharmacy: Delivery Available after 12 noon.
  Burgio's Pharmacy: Delivery Available after 3pm, Mon-Fri.
  
  Any questions, please contact your local pharmacy staff. Thank you!
- STORE HOURS:
  
  Mon: 9AM – 8PM
  Tues: 9AM – 8PM
  Wed: 9AM – 8PM
  Thurs: 9AM – 8PM
  Friday: 9AM – 7PM
  Saturday: 9AM – 4PM
  Sunday CLOSED
  
  STORE ADDRESS:
  
  300 Sicomac Avenue
  Wyckoff, NJ 07481
  Tel: (201) 891-0822
  Fax: (201) 891-4790
Full Address Required For Delivery *
Final Comments
Additional items, Comments Or Changes:
Should be Empty:

February 2016
31	1	2	3	4	5	6
7	8	9	10	11	12	13
14	15	16	17	18	19	20
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28	29	1	2	3	4	5
6	7	8	9	10	11	12
13	14	15	16	17	18	19

Prescription Refill(s): Burgio's
Enter Your Personal Information
First Name *
Last Name *
Email *
Phone * (Just numbers. No dashes, dots or parentheses please.)
Select Your Prescriptions
- Patient Name *
- Rx No
- Med. Name
- [ADD MORE]
Pick-Up or Delivery
Please Select:
Pick-Up: or Delivery:
- PICKUP:
  Prescriptions are usually available for pickup 2 hours after submission of this form. Thus your order should be ready by the approximately time listed below provided the prescription are valid refills and the medication is in stock. For urgent requests please call the store directly.
  Availability: After 1pm*
  *Please note the store hours listed here. Orders are not available after hours. In this case, they will be available the next business day.
- STORE HOURS:
  
  Mon: 9AM – 7PM
  Tues: 9AM – 7PM
  Wed: 9AM – 7PM
  Thurs: 9AM – 7PM
  Friday: 9AM – 7PM
  Saturday: 9AM – 4PM
  Sunday: 9AM – 1PM
  
  STORE ADDRESS:
  
  137 Union Blvd.
  Totowa, NJ 07512
  Tel: (973) 790-3711
  Fax: (973) 790-1279
- DELIVERY:
  Prescriptions will be delivered within 2-6 hours after submission of this form. If the form is submitted within 2 hours of closing or overnight, delivery will be scheduled for the next business day. For urgent requests please call the store directly. Please indicate in the notes section below what day/time you plan to pick up your medication so we can ensure it is ready for you.
  
  *Please note the store hours listed here. Delivery service is available after the following times until close of business for the following stores.
  
  Sicomac Pharmacy: Delivery available after 11am
  DeBlieck's Pharmacy: Delivery available after 11am
  Ho-Ho-Kus Pharmacy: Delivery Available after 12 noon.
  Burgio's Pharmacy: Delivery Available after 3pm, Mon-Fri.
  
  Any questions, please contact your local pharmacy staff. Thank you!
- STORE HOURS:
  
  Mon: 9AM – 7PM
  Tues: 9AM – 7PM
  Wed: 9AM – 7PM
  Thurs: 9AM – 7PM
  Friday: 9AM – 7PM
  Saturday: 9AM – 4PM
  Sunday: 9AM – 1PM
  
  STORE ADDRESS:
  
  137 Union Blvd.
  Totowa, NJ 07512
  Tel: (973) 790-3711
  Fax: (973) 790-1279
Full Address Required For Delivery *
Final Comments
Additional items, Comments Or Changes:
Should be Empty:

Prescription Refills

Choose Your Pharmacy

Prescription Refill(s): De Blieck's

Enter Your Personal Information

Select Your Prescriptions

Pick-Up or Delivery

Final Comments

Prescription Refill(s): Ho-Ho-Kus

Enter Your Personal Information

Select Your Prescriptions

Pick-Up or Delivery

Final Comments

Prescription Refill(s): Sicomac

Enter Your Personal Information

Select Your Prescriptions

Pick-Up or Delivery

Final Comments

Prescription Refill(s): Burgio's

Enter Your Personal Information

Select Your Prescriptions

Pick-Up or Delivery

Final Comments

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