OrganizationActive
Mashantucket Pequot Tribal
NPI 1003036435 · Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy · Mashantucket, CT
Provider details
- NPI number
- 1003036435
- Entity type
- Organization
- Primary specialty
- Indian Health Service/Tribal/Urban Indian Health (I/T/U) PharmacySuppliers
- Organization subpart
- No
- Authorized official
- Edward Moldenhauer, Director of Pharmacy Operation(860) 396-2058
Specialties & taxonomies
- Indian Health Service/Tribal/Urban Indian Health (I/T/U) PharmacyPrimary332800000XLicense ISH285960015 (CT)
Suppliers
- Mail Order Pharmacy3336M0002X
Suppliers
- Managed Care Organization Pharmacy3336M0003X
Suppliers
- Pharmacy333600000X
Suppliers
Practice location
1 Annie George Dr
Mashantucket, CT 06338-3801
Phone: (860) 396-6438
Fax: (866) 396-6212
Approximate (ZIP-level) locationGet directions
Mailing address
1 Annie George Dr
Mashantucket, CT 06338-3801
Other names (DBA / former)
- Doing business as
- Pequot Health Care
Registry dates
- Enumerated
- 2007-04-26
- Last updated
- 2011-04-01
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.