OrganizationActive
Mashantucket Pequot Tribal
NPI 1578886461 · Mail Order Pharmacy · Mashantucket, CT
Provider details
- NPI number
- 1578886461
- Entity type
- Organization
- Primary specialty
- Mail Order PharmacySuppliers
- Organization subpart
- No
- Authorized official
- Edward Moldenhauer, Director of Pharmacy Operation(860) 396-2058
- License
- 285960015 (CT)
Specialties & taxonomies
Suppliers
Practice location
1 Annie George Dr
Bldg 1
Mashantucket, CT 06338-3801
Phone: (860) 396-6438
Fax: (800) 779-6329
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
- 2010-03-05
- 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.