Someone new to the area searches “pharmacy near me”. Google shows the chain first because its listing is complete, active, and has 400 reviews. Yours is closer, faster, and cheaper on half their generics, and it is the third tap down — the one nobody makes.
The frustrating part is you know exactly what would change their mind, because you say it every day at the counter: we will call the doctor for you, we deliver, we can compound that. None of it is anywhere Google can see.
So you keep running on the customers you already have, and that base ages. A few move away, a few get moved by a PBM mail-order mandate, and replacement customers do not arrive because nobody new is finding you. Margins are already thin enough that any lost script matters.
Then the chain across the street cuts hours and you get a burst of walk-ins asking whether you are still open — because your listing has not been updated since the pandemic and they genuinely could not tell.