Provider Demographics
NPI:1477387819
Name:SEQUON LLC
Entity type:Organization
Organization Name:SEQUON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:GANSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-394-5671
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:
Practice Address - Street 1:600 JACKSON ST STE Q
Practice Address - Street 2:ROOM 137
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-5719
Practice Address - Country:US
Practice Address - Phone:540-315-8446
Practice Address - Fax:540-907-4372
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SEQUON LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy