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BVL Pharma
Phone
8500632792
Fax
8500632792
Print Dt:
9/20/2018
Rx Pres:
PETER TEST
#10 DOENING ST,
IMALY CITY, MI 48444
Phn:
7793941502
FAX:
7793941502
Ord:
NPI#
LIC#:
3333
Prescription Id#:
TA12345
Patient:
TEST JOE
DOB:
12/12/1995
Gender:
M
Address:
1122 TEST AVE
CARO, MI 48723
Phone
9703690858
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This Prescription Will be Filled Generically Unless Prescriber Writes "DAW" in the Box
N
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