Provider Demographics
NPI:1841908084
Name:SEQUON LLC
Entity type:Organization
Organization Name:SEQUON LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
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 1:1398 LAMBERTON DR STE 202
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-3414
Practice Address - Country:US
Practice Address - Phone:301-960-8003
Practice Address - Fax:301-960-3530
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SEQUON LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-11-07
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDPW0542OtherMARYLAND BOARD OF PHARMACY