Provider Demographics
NPI:1861824336
Name:ELZY, CAROL E (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:E
Last Name:ELZY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 COTTONTAIL LN
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:IL
Mailing Address - Zip Code:61951-1611
Mailing Address - Country:US
Mailing Address - Phone:217-728-4264
Mailing Address - Fax:
Practice Address - Street 1:121 W SPRINGFIELD RD
Practice Address - Street 2:
Practice Address - City:ARCOLA
Practice Address - State:IL
Practice Address - Zip Code:61910-1302
Practice Address - Country:US
Practice Address - Phone:217-268-3838
Practice Address - Fax:217-268-3858
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS31209183500000X
IL051040928183500000X
NE10896183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist