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Otic (Ear)
/ Clindamycin/ Sulfadiazine/ Erythromycin/ Triamcinolone Acetazolamide Ear Ointment
Clindamycin/ Sulfadiazine/ Erythromycin/ Triamcinolone Acetazolamide Ear Ointment
$
44.00
Ear Ointment Strength
Choose an option
1/1/1/0.1%
Ear Ointment Size
Choose an option
30GM
Clear
$
Clinic Name
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Clinic name
Clinic Phone Number
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Clinic phone number
Clinic State
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Person Placing
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Full Name of Person(s) who can verify the order
Order Type
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Select type of Order (Who is Paying)
Bill and Ship Clinic
Bill and Ship Owner
Bill Clinic and Ship Owner
Owner Name
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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)
Reasoning/ Rational
*
Per Clinic this drug would make a Clinical Difference for this patient because it is not available in dosage...
Strength
Form
Flavor
Combination
Allergy
Discontinued
Backorder
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Refills
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Number of Refills (0-PRN)
Doctor's Name
*
Prescribing doctor's name is it appears on their license
License Number
Prescribing 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?
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No
Clindamycin/ Sulfadiazine/ Erythromycin/ Triamcinolone Acetazolamide Ear Ointment quantity
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SKU:
N/A
Category:
Otic (Ear)
Additional information
Reviews (0)
Additional information
Ear Ointment Strength
1/1/1/0.1%
Ear Ointment Size
30GM
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