Healthcare Provider Details

I. General information

NPI: 1568378065
Provider Name (Legal Business Name): AELYON PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 YORK RD
LUTHERVILLE TIMONIUM MD
21093-5620
US

IV. Provider business mailing address

1521 YORK RD
LUTHERVILLE TIMONIUM MD
21093-5620
US

V. Phone/Fax

Practice location:
  • Phone: 352-215-5706
  • Fax: 202-217-3161
Mailing address:
  • Phone: 352-215-5706
  • Fax: 202-217-3161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. MOISE NGWA
Title or Position: CEO AND FOUNDER
Credential:
Phone: 352-215-5706