Mashantucket Pequot Tribal
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy in Mashantucket, Connecticut
1003036435- Practice location
- 1 Annie George Dr, Mashantucket, CT 06338-3801
- Phone
- 860-396-6438
- Fax
- 866-396-6212
- Last updated
- April 1, 2011
Mashantucket Pequot Tribal is a healthcare organization based in Mashantucket, CT. Mashantucket Pequot Tribal practices in Mashantucket, CT. The NPI Number for Mashantucket Pequot Tribal is 1003036435 and holds a License No. ISH285960015 (CT). The current practice location address for Mashantucket Pequot Tribal is 1 Annie George Dr, Mashantucket, CT 06338-3801 and can be reached out via phone at 860-396-6438 and via fax at 866-396-6212.
Provider Profile Details
- NPI Number
- 1003036435
- Provider Name
- Mashantucket Pequot Tribal
- Provider Entity Type
- Organization
- Address
- 1 Annie George Dr, Mashantucket, CT 06338-3801
- Phone Number
- 860-396-6438
- Fax Number
- 866-396-6212
- Primary Taxonomy
- Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy · 332800000X
- Organization Subpart
- No
- Authorized Official
- Edward Moldenhauer, MS BS PHARM · Director Of Pharmacy Operation · 860-396-2058
- Other Names
- Pequot Health Care (Doing Business As)
- Provider Enumeration Date
- April 26, 2007
- Last Update Date
- April 1, 2011
- NPI Status
- Active
Provider Business Practice Location Address Details
- Address
- 1 Annie George Dr
Mashantucket, CT 06338-3801 - City
- Mashantucket
- State
- Connecticut
- Zip
- 06338-3801
- Phone Number
- 860-396-6438
- Fax Number
- 866-396-6212
Provider Business Mailing Address Details
- Address
- 1 Annie George Dr
Po Box 3559
Mashantucket, CT 06338-3801 - City
- Mashantucket
- State
- CT
- Zip
- 06338-3801
- Phone Number
- 860-369-2058
- Fax Number
- 860-396-6212
License Information
- Taxonomy (1)
- Pharmacy, Mail Order Pharmacy · 3336M0002X
- Taxonomy (2)
- Pharmacy, Managed Care Organization Pharmacy · 3336M0003X
- Taxonomy (3)
- Pharmacy · 333600000X
- License Number (4)
- ISH285960015
- License State (4)
- CT
- Taxonomy (4)
- Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy · 332800000X · Primary
Legacy Identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| No legacy identifiers (Medicaid, Medicare or plan IDs) are on file for this provider. | |||
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Frequently Asked Questions
What is the NPI number of Mashantucket Pequot Tribal?
The NPI number of Mashantucket Pequot Tribal is 1003036435. It was assigned on April 26, 2007 and is currently active in the NPPES registry.
What is the specialty of Mashantucket Pequot Tribal?
Mashantucket Pequot Tribal is registered under the primary taxonomy Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy (code 332800000X), licensed in CT under license number ISH285960015.
Where does Mashantucket Pequot Tribal practice?
The practice location is 1 Annie George Dr, Mashantucket, CT 06338-3801. The office can be reached at 860-396-6438 (phone) or 866-396-6212 (fax).
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). It is used in HIPAA standard transactions.
How do I verify this NPI record?
This record is sourced from the public NPPES NPI Registry maintained by CMS. You can confirm it by searching NPI 1003036435 directly on the NPPES registry website.