Customer Information Form

From new addresses to personal health updates, keeping your account information current ensures you receive the best service from Women’s International Pharmacy.

Be assured that this information will remain confidential.

You can also print out the Customer Information Form and return completed by fax or mail.

Mail or Fax All Forms and Photocopies To:

2 Marsh Court
Madison, WI 53718

Fax: (800) 279-8011