=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326379520
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EASY SCRIPTS INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/27/2010
-----------------------------------------------------
Last Update Date | 01/27/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2307 S MOUNT PROSPECT RD
-----------------------------------------------------
City | DES PLAINES
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60018-1811
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-849-6634
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2307 S MOUNT PROSPECT RD
-----------------------------------------------------
City | DES PLAINES
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60018-1811
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-849-6634
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR/PHARMACIST
-----------------------------------------------------
Name | SHAWN E TAVARES
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 808-873-6424
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 054.016789
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------