Provider Demographics
NPI:1447614839
Name:EL ELYON PHARMACEUTICAL INC
Entity Type:Organization
Organization Name:EL ELYON PHARMACEUTICAL INC
Other - Org Name:GARWYN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:TAMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:667-205-1134
Mailing Address - Street 1:2300 GARRISON BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21216
Mailing Address - Country:US
Mailing Address - Phone:667-205-1134
Mailing Address - Fax:667-205-1136
Practice Address - Street 1:2300 GARRISON BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21216-2335
Practice Address - Country:US
Practice Address - Phone:667-205-1134
Practice Address - Fax:667-205-1136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-12
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MDP071143336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2159649OtherPK
MD511045900Medicaid