Ammonium Chloride Powder

Price range: $38.00 through $91.00

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Clinic Name *Clinic name

Clinic Phone Number *Clinic phone number

Clinic State *State the clinic is located in

Person Placing *Full Name of Person(s) who can verify the order

Order Type *Select type of Order (Who is Paying)

Bill and Ship Clinic

Bill and Ship Owner

Bill Clinic and Ship Owner

Owner Name *Owner's full name

Owner Phone Number *Owner's phone number

Is this a refill?

Pet Name *Pet's full name

Pet Species *Species of pet

Sig *Sig (Directions)

Refills *Number of Refills (0-PRN)

Medical Rationale *

Doctor's Name *Prescribing doctor's name is it appears on their license

License NumberPrescribing doctor's license number

Question *Do you understand that we are a Compounding Pharmacy and that this drug is made from a bulk medication that isn't commercially available in this form, strength, or flavor?

Yes

SKU: N/A Category: Powder

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Additional information

Powder Strength	1 gm/scp, 2.5 gm/scp, 5 gm/scp
Powder Size	100 scp, 150 scp, 200 scp, 30 scp, 60 scp

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Ammonium Chloride Powder

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