MEDICARE: DR. CAROL E ELZY PHARMD

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	PS31209	FL
2	183500000X	Pharmacist	051040928	IL
3	183500000X	Pharmacist	10896	NE

General Provider Information

NPI Number	:	1861824336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROL E ELZY PHARMD

Provider Business Mailing Address
First Line	:	19 COTTONTAIL LN
Second Line	:
City	:	SULLIVAN
State	:	IL
Zip	:	61951-1611
Country	:	US
Telephone Number	:	217-728-4264
Fax Number	:

Provider Business Practice Location Address
First Line	:	121 W SPRINGFIELD RD
Second Line	:
City	:	ARCOLA
State	:	IL
Zip	:	61910-1302
Country	:	US
Telephone Number	:	217-268-3838
Fax Number	:	217-268-3858

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

Provider Enumeration Date	:	08/06/2013
Last Update Date	:	08/06/2013

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