Alto Pharmacy's reputation, as illustrated by the collection of customer reviews, exhibits a mix of significant satisfaction and critical issues. Users praise the convenience of home delivery, the inclusion of small tokens such as caramels, and the personal touch of friendly delivery personnel. Instances where Alto shines seem to be around the areas of convenience and proactive communication, like refill reminders, which enhance the customer experience. However, a growing concern is the variability in service quality, particularly with customer support responsiveness and prescription stock levels. Several reviewers describe experiences of service decline, with longer wait times on calls, inconsistent information from staff, and challenges with the online communication channels. The stock shortages and late notifications of unavailable medications are prominent pain points for customers, with some highlighting organizational changes and new executive leadership as turning points in their declining experience. Such mixed feedback suggests that while Alto Pharmacy maintains loyal customers due to certain unique services and conveniences, systemic issues in the operational and customer service domains are adversely affecting their overall reputation.