ONLINE PHARMACY
Apothecary at STVE, 50 Medical Park East Drive, Birmingham, AL 35235
Phone: (205) 838-3130; Fax: (205) 838-3851

STEP  1  2  3
PLEASE ENTER ALL INFORMATION AND THEN CLICK ON THE ORDER BUTTON
 Last Name
 First Name
Middle Initial
 Date of Birth (mm/dd/yyyy)
 Email Address
Phone Number(s) Home
Work
Cell
  Prescription Number(s)
IF THERE ARE NO REFILLS REMAINING ON YOUR PRESCRIPTIONS –
PLEASE REQUEST NEW PRESCRIPTIONS FROM YOUR DOCTOR
Delivery Method
 Address
 City
State                    Zip Code
 Payment Method
 Cardholder Name
 Credit Card Number
 Expiration Date (mm/yy) / Your credit card expired!
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