Healthcare Provider Details

I. General information

NPI: 1861824336
Provider Name (Legal Business Name): CAROL E ELZY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2013
Last Update Date: 08/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 W SPRINGFIELD RD
ARCOLA IL
61910-1302
US

IV. Provider business mailing address

19 COTTONTAIL LN
SULLIVAN IL
61951-1611
US

V. Phone/Fax

Practice location:
  • Phone: 217-268-3838
  • Fax: 217-268-3858
Mailing address:
  • Phone: 217-728-4264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS31209
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051040928
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10896
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: