MASHANTUCKET PEQUOT TRIBAL NPI 1720024524

NPI Information

  • NPI: 1720024524
  • Provider Name: MASHANTUCKET PEQUOT TRIBAL
  • Classification: Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy - 332800000X
  • Entity Type: Organization
  • :
  • Address: 1 ANNIE GEORGE DRIVE
    BLDG 1
    MASHANTUCKET, CT
    ZIP 06338
  • Phone: (860) 396-6435

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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 1720024524. The provider is registered as an organization entity type.
The provider .

The provider's business location address is:

1 ANNIE GEORGE DRIVE
BLDG 1
MASHANTUCKET, CT
ZIP 06338-801
Phone: (860) 396-6435
Fax: (800) 779-6329

The provider's authorized official is John Grossomanides .
The authorized official title is Director Of Pharmacy Services and has the following contact phone number (860) 396-6435.

The enumeration date for this NPI number is 6/21/2006 and was last updated on 4/16/2025.

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
1332800000XIndian Health Service/Tribal/Urban Indian Health (I/T/U) PharmacyYes
2333600000XPharmacyNo
33336M0002XPharmacyMail Order PharmacyNo

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
1004129210MEDICAIDCONNECTICUT
22000351OTHERPK

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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