Provider Demographics
NPI:1235864448
Name:SEQUON LLC
Entity Type:Organization
Organization Name:SEQUON LLC
Other - Org Name:ALTRUIX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:LIEBMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-300-0102
Mailing Address - Street 1:601 CHINQUAPIN ROUND RD
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-4009
Mailing Address - Country:US
Mailing Address - Phone:443-837-0200
Mailing Address - Fax:410-990-4455
Practice Address - Street 1:1111 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08332-1581
Practice Address - Country:US
Practice Address - Phone:856-300-2455
Practice Address - Fax:856-300-0102
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SEQUON, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-07-21
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy