Healthcare Provider Details

I. General information

NPI: 1841908084
Provider Name (Legal Business Name): SEQUON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2022
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1398 LAMBERTON DR STE 202
SILVER SPRING MD
20902-3414
US

IV. Provider business mailing address

601 CHINQUAPIN ROUND RD
ANNAPOLIS MD
21401-4009
US

V. Phone/Fax

Practice location:
  • Phone: 301-960-8003
  • Fax: 301-960-3530
Mailing address:
  • Phone: 443-837-0200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: GREG GANSE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 717-394-5671