=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235864448
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SEQUON LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/21/2022
-----------------------------------------------------
Last Update Date | 10/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 60 W LANDIS AVE STE A4
-----------------------------------------------------
City | VINELAND
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08360-8132
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-300-2455
-----------------------------------------------------
Fax | 856-300-0102
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 40 WIGHT AVE STE 100
-----------------------------------------------------
City | COCKEYSVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21030-2148
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 667-408-7767
-----------------------------------------------------
Fax | 877-829-1925
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF OPERATIONS OFFICER
-----------------------------------------------------
Name | DANIEL MANDOLI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 667-408-7767
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------