MEDICARE: SEQUON, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0002X	Clinic Pharmacy

General Provider Information

NPI Number	:	1043531791
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEQUON, INC.

Provider Business Mailing Address
First Line	:	9030 ROUTE 108
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-1990
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9030 ROUTE 108
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-1990
Country	:	US
Telephone Number	:	410-292-3730
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOEL F FELDMAN
Credential	:
Telephone Number	:	410-292-3730

Provider Enumeration Date	:	06/17/2010
Last Update Date	:	06/17/2010

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Directions to “SEQUON, INC. ” Practice Location

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