MASHANTUCKET PEQUOT TRIBAL (NPI# 1578886461) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578886461 |
| Entity Type | Organization |
| Organization Name | MASHANTUCKET PEQUOT TRIBAL |
| Other Organization Name | PEQUOT HEALTH CARE |
| Practice Address |
1 Annie George Dr Bldg 1 Mashantucket CT 06338-3801 |
| Mailing Address |
1 Annie George Dr Po Box 3559 Mashantucket CT 06338-3801 |
| Practice Telephone | 8603966438 |
| Practice Fax Number | 8007796329 |
| Mailing Telephone | 8603962058 |
| Mailing Fax Number | 8603966212 |
| Enumeration Date | 2010-03-05 |
| Last Update Date | 2011-04-01 |
| Authorized Official Name | EDWARD MOLDENHAUER (DIRECTOR OF PHARMACY OPERATION) |
| Authorized Official Telephone | 8603962058 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3336M0002X |
Pharmacy Specialization: Mail Order Pharmacy |
285960015 | CT | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CT | 004129210 | 05 | |
| NCPDP PROVIDER IDENTIFICATION NUMBER | 0721820 | 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 |
| 1003036435 | Mashantucket Pequot Tribal | Pharmacy | 1 Annie George Dr, Mashantucket, CT 06338-3801 | 2007-04-26 |
| Street Address |
1 ANNIE GEORGE DR BLDG 1 |
| 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 |
| 1003036435 | Mashantucket Pequot Tribal | Pharmacy | 1 Annie George Dr, Mashantucket, CT 06338-3801 | 2007-04-26 |
| 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 | 3336M0002X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Mail Order Pharmacy |
| A pharmacy where pharmacists compound or dispense prescriptions or other medications in accordance with federal and state law, using common carriers to deliver the medications to patient or their caregivers. Mail order pharmacies counsel patients and caregivers (sometimes independent of the dispensing process) through telephone or email contact and provide other professional services associated with pharmaceutical care appropriate to the setting. Mail order pharmacies are licensed as a Mail Order Pharmacy in the state where they are located and may also be licensed or registered as nonresident pharmacies in other states. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003036435 | Mashantucket Pequot Tribal | Pharmacy | 1 Annie George Dr, Mashantucket, CT 06338-3801 | 2007-04-26 |
| 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.