Healthcare Provider Details

I. General information

NPI: 1114438504
Provider Name (Legal Business Name): TELESCRIPT PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2017
Last Update Date: 05/09/2022
Certification Date: 05/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

687 WAUKEGAN RD
DEERFIELD IL
60015-4331
US

IV. Provider business mailing address

687 WAUKEGAN RD
DEERFIELD IL
60015-4331
US

V. Phone/Fax

Practice location:
  • Phone: 630-299-3900
  • Fax: 630-429-9704
Mailing address:
  • Phone: 630-299-3900
  • Fax: 630-429-9704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. BRENT CORBIN EDELCUP
Title or Position: PRESIDENT
Credential: PHARMD
Phone: 847-800-2138