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Pharmskills Online - (V2) Product Verification Queue - View Detail

ELECTRONIC PRESCRIPTION
Date: 10/13/2025 at 02:47 AM
Patient: Mary F. Mott
Address: 906 Harvard
Drug: Dexilant 30 mg Capsule
Dispense: 30
SIG: i po QD for GERD
Refills: 0
DAW: substitution permitted
Prescriber: James T. Warren
Address: 3-G Medical Arts Building
DEA#: AW1351977
Rx#
4877509
Written Date
10/13/2025
Name
Mary F. Mott
DOB
5/3/1985
Age
40
Address
906 Harvard
Phone
(316) 555-8318
Allergies
Prescriber
James T. Warren
Practice
Hometown Family Medicine
Address
3-G Medical Arts Building
Fax
(785) 555-5567
DEA
AW1351977
NPI
6379131958
Phone
(785) 555-5566
Dispensed
Dexlansoprazole 30 mg Delayed-Release Capsule
NDC #
00378-2085-93
Mfg
Mylan
Pres Qty
30
Dis Qty
15 (pt. request partial fill)
Day Supply
15
Refills
1
DAW
0
Origin Code
3
Instructions
Take 1 capsule by mouth once daily for GERD.
Dispensing Notes

 
Product Verification
Bag Tag
Counting Verification


Patient Name: Mary Matt
Address: 906 Cambridge
Stock Bottle


00378-2085-93
NDC: 00378-2085-93

Lot #: 849234
Exp Date: 2/28/2026
Pharmacist Action