MASHANTUCKET PEQUOT TRIBAL (NPI# 1003036435) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003036435 |
| Entity Type | Organization |
| Organization Name | MASHANTUCKET PEQUOT TRIBAL |
| Other Organization Name | PEQUOT HEALTH CARE |
| Practice Address |
1 Annie George Dr Mashantucket CT 06338-3801 |
| Mailing Address |
1 Annie George Dr Po Box 3559 Mashantucket CT 06338-3801 |
| Practice Telephone | 8603966438 |
| Practice Fax Number | 8663966212 |
| Mailing Telephone | 8603692058 |
| Mailing Fax Number | 8603966212 |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2011-04-01 |
| Authorized Official Name | EDWARD MOLDENHAUER (DIRECTOR OF PHARMACY OPERATION) |
| Authorized Official Telephone | 8603962058 |
| Authorized Official Credential | MS BS PHARM |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 3336M0002X |
Pharmacy Specialization: Mail Order Pharmacy |
Suppliers | ||
| N | 3336M0003X |
Pharmacy Specialization: Managed Care Organization Pharmacy |
Suppliers | ||
| N | 333600000X | Pharmacy | Suppliers | ||
| Y | 332800000X | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | ISH285960015 | CT | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CT | 004129210 | 05 | |
| NCPDP PROVIDER IDENTIFICATION NUMBER | 0718619 | 01 |
| Other Name | Type Code |
|---|---|
| PEQUOT HEALTH CARE | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720024524 | Mashantucket Pequot Tribal | Pharmacy | 1 Annie George Dr, Bldg 1, Mashantucket, CT 06338-3801 | 2006-06-21 |
| 1578886461 | Mashantucket Pequot Tribal | Pharmacy | 1 Annie George Dr, Bldg 1, Mashantucket, CT 06338-3801 | 2010-03-05 |
| Street Address |
1 ANNIE GEORGE DR |
| City | MASHANTUCKET |
| State | CT |
| Zip Code | 06338-3801 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720024524 | Mashantucket Pequot Tribal | Pharmacy | 1 Annie George Dr, Bldg 1, Mashantucket, CT 06338-3801 | 2006-06-21 |
| 1053772657 | Carol Lea Ours | Pharmacist | 1 Annie George Dr, Mashantucket, CT 06338-3801 | 2016-03-10 |
| 1891156493 | Carla O'donnell | Pharmacist | 1 Annie George Dr, Mashantucket, CT 06338-3801 | 2016-03-10 |
| 1831559855 | Millie White | Pharmacist | 1 Annie George Dr, Mashantucket, CT 06338-3801 | 2016-03-03 |
| 1538445747 | Ian Parnigoni | Pharmacist | 1 Annie George Dr, Mashantucket, CT 06338-3801 | 2011-11-01 |
| 1285912808 | Jennifer Mccue | Pharmacist | 1 Annie George Dr, Bldg 1, Mashantucket, CT 06338-3801 | 2011-07-31 |
| 1407166846 | Timothy J Poole | Pharmacist | 1 Annie George Dr, Mashantucket, CT 06338-3801 | 2010-10-19 |
| 1639480163 | Catherine Ann Koivisto | Pharmacist | 1 Annie George Dr, Mashantucket, CT 06338-3801 | 2010-06-30 |
| 1487978177 | Amy D Ricupero | Pharmacist | 1 Annie George Dr, Mashantucket, CT 06338-3801 | 2010-03-24 |
| 1578886461 | Mashantucket Pequot Tribal | Pharmacy | 1 Annie George Dr, Bldg 1, Mashantucket, CT 06338-3801 | 2010-03-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962551804 | Patricia L Sebastian | Family Medicine | 75 Rt 2, Manshantucket Pequot Tribal Healt Services, Ledyard, CT 06338-3260 | 2007-01-09 |
| 1194254144 | Crystal Roach | Social Worker | 102 Muhshee Mahchaq Blvd, Mashantucket, CT 06338-3820 | 2017-06-05 |
| Taxonomy Code | 332800000X |
| Grouping | Suppliers |
| Classification | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy |
| An Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy means a pharmacy operated by the Indian Health Service, an Indian tribe or tribal organization, or an urban Indian organization, all of which are defined in Section 4 of the Indian Health Care Improvement Act, 25 U.S.C. 1603. |
| Notes: Source: The Medicare Prescription Drug, Improvement and Modernization Act of 2003 [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326313677 | Mohegan Tribe of Indians of Ct | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 67 Sandy Desert Rd, Uncasville, CT 06382-1111 | 2012-03-20 |
| City | MASHANTUCKET |
| Zip Code | 06338 |
Please comment or provide details below to improve the information on MASHANTUCKET PEQUOT TRIBAL.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.