MEDICARE: SAMIR ELABBADI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	051.303756	IL

General Provider Information

NPI Number	:	1659956498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMIR ELABBADI

Provider Business Mailing Address
First Line	:	214 PINE SHORE DR APT 54
Second Line	:
City	:	CARBONDALE
State	:	IL
Zip	:	62902-7505
Country	:	US
Telephone Number	:	773-990-9717
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 N GIANT CITY RD
Second Line	:
City	:	CARBONDALE
State	:	IL
Zip	:	62902-6417
Country	:	US
Telephone Number	:	618-457-5313
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/12/2021
Last Update Date	:	03/12/2021

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Directions to “ SAMIR ELABBADI ” Practice Location

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