Provider Demographics
NPI:1255836938
Name:EDELCUP, BRENT CORBIN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:CORBIN
Last Name:EDELCUP
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:687 WAUKEGAN RD
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-4331
Mailing Address - Country:US
Mailing Address - Phone:630-299-3900
Mailing Address - Fax:630-429-9704
Practice Address - Street 1:687 WAUKEGAN RD
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-4331
Practice Address - Country:US
Practice Address - Phone:630-299-3900
Practice Address - Fax:630-429-9704
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051300771183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist