MASHANTUCKET PEQUOT TRIBAL NPI 1003036435

NPI Information

  • NPI: 1003036435
  • Provider Name: MASHANTUCKET PEQUOT TRIBAL
  • Classification: Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy - 332800000X
  • Entity Type: Organization
  • Doing Business As: PEQUOT HEALTH CARE
  • Address: 1 ANNIE GEORGE DR
    MASHANTUCKET, CT
    ZIP 06338
  • Phone: (860) 396-6438

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NPI Details

MASHANTUCKET PEQUOT TRIBAL is an indian health service tribal urban indian health i t u pharmacy in Mashantucket, CT. The provider is 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. MASHANTUCKET PEQUOT TRIBAL NPI is 1003036435. The provider is registered as an organization entity type.
The provider Is Doing Business As Pequot Health Care.

The provider's business location address is:

1 ANNIE GEORGE DR
MASHANTUCKET, CT
ZIP 06338-801
Phone: (860) 396-6438
Fax: (866) 396-6212

The provider's authorized official is Edward Moldenhauer .
The authorized official title is Director Of Pharmacy Operation and has the following contact phone number (860) 396-2058.

The enumeration date for this NPI number is 4/26/2007 and was last updated on 4/1/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
13336M0002XPharmacyMail Order PharmacyNo
23336M0003XPharmacyManaged Care Organization PharmacyNo
3333600000XPharmacyNo
4332800000XIndian Health Service/Tribal/Urban Indian Health (I/T/U) PharmacyISH285960015CONNECTICUTYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
10718619OTHERNCPDP PROVIDER IDENTIFICATION NUMBER
2004129210MEDICAIDCONNECTICUT

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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