Healthcare Provider Details

I. General information

NPI: 1245194927
Provider Name (Legal Business Name): SEQUON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 WASHINGTON ST STE 110
HUNTINGDON PA
16652-1722
US

IV. Provider business mailing address

40 WIGHT AVE STE 100
COCKEYSVILLE MD
21030-2148
US

V. Phone/Fax

Practice location:
  • Phone: 814-996-2838
  • Fax: 814-996-2830
Mailing address:
  • Phone: 667-408-7767
  • 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: DANIEL MANDOLI
Title or Position: COO
Credential:
Phone: 314-494-7493