232 East Davis Blvd, Tampa, FL 33606  |  Phone: 813-254-1888

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CUSTOMIZE YOUR PAIN COMPOUND

FILL OUT THE FOLLOWING FORM TO REQUEST A CUSTOMIZED PAIN COMPOUND QUOTE FROM OUR LAB

Example: Lidocaine, Naltrexone, Gabapentin, etc.
Example: Capsule, Cream, Solution, etc.
Example: #30 capsules, 15 grams, 100mL, etc.
Example: 30, 60, 90, etc.
Example: 100mg, 5%, 10mg/mL, etc.
Example: 1 Capsule daily, 0.5 gm twice daily, 5mL at bedtime, 2 pumps daily, etc.

Patient Info

MM/DD/YYYY

Notification & Delivery Preferences

Davis Islands Pharmacy

Phone: 813-254-1888
Fax: 813-254-8396
Email: rx@davisislandspharmacy.com
Address: 232 East Davis Blvd, Tampa, FL 33606

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