Doctor’s Portal – Millers Pharmacy

Doctor's Portal

Millers has offered Traditional and Compounding medications for over 100 years.

We are Nationally Accredited, Licensed in 50 States, CVS Preferred Pharmacy, COSTCO Compounding and In-house clean rooms.

Most Insurance Accepted

Contact Us

Doctor Patient Prescription Form

Or download PDF Below and Fax: 201-891-1312

Patient's First Name

Patient's Last Name

Patient's Phone

Patient's Secondary Phone

Address

City / State / Zip

Allergies

SIG

Write Prescription / Additional Comments

Doctor

Doctor's Phone

NPI #

DEA #

Office Manager

Phone

Office FAX

Office Email

Signature

Date

Important Notice: Click the above button, form tab will open, Fill in all the information and click on the download button on top right corner and select “Download with your changes” from the drop down options.

INSTRUCTIONS FOR ELECTRONIC FILLABLE FORM

OTHER PRESCRIPTION ORDER FORMS

Select form below, Download , Open file and then Save file under the patient's name. Then you are ready to complete the electronic form and fax to 201-891-1312 or email info@yourliferx.com

Doctor's Portal

Millers has offered Traditional and Compounding medications for over 100 years.

Contact Us

Call Us: 201 891 3333

Text Us: 201 308 0133

Fax: 201 891 1312

Electronic Prescriptions

Doctor Patient Prescription Form

OTHER PRESCRIPTION ORDER FORMS

QUICK LINKS

CONTACT US