OrganizationActive
Mashantucket Pequot Tribal
NPI 1720024524 · Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy · Mashantucket, CT
Provider details
- NPI number
- 1720024524
- Entity type
- Organization
- Primary specialty
- Indian Health Service/Tribal/Urban Indian Health (I/T/U) PharmacySuppliers
- Parent organization
- Mashantucket Pequot Tribal
- Organization subpart
- Yes
- Authorized official
- John Grossomanides, Director of Pharmacy Services(860) 396-6435
Specialties & taxonomies
Suppliers
- Pharmacy333600000X
Suppliers
- Mail Order Pharmacy3336M0002X
Suppliers
Practice location
1 Annie George Drive
Bldg 1
Mashantucket, CT 06338-3801
Phone: (860) 396-6435
Fax: (800) 779-6329
Approximate (ZIP-level) locationGet directions
Mailing address
1 Annie George Drive
Mashantucket, CT 06338-3801
Other names (DBA / former)
- Doing business as
- Pequot Health Care
Registry dates
- Enumerated
- 2006-06-21
- Last updated
- 2025-04-16
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.