Provider Demographics
NPI:1285510990
Name:SEQUON, LLC
Entity type:Organization
Organization Name:SEQUON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MANDOLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-494-7493
Mailing Address - Street 1:40 WIGHT AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-2148
Mailing Address - Country:US
Mailing Address - Phone:667-408-7767
Mailing Address - Fax:
Practice Address - Street 1:590 NAAMANS RD STE 202
Practice Address - Street 2:
Practice Address - City:CLAYMONT
Practice Address - State:DE
Practice Address - Zip Code:19703-2308
Practice Address - Country:US
Practice Address - Phone:302-625-0350
Practice Address - Fax:302-625-0349
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SEQUON, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-08-15
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy