Pequot Health Care

LBN: Mashantucket Pequot Tribal
Pequot Health Care is an health care organization with primary practice located at 1 Annie George Dr , Mashantucket CT 06338-3801. The organization recently has 4 registered licenses in different health care specialties including Suppliers / Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy, Suppliers / Pharmacy, Suppliers / Mail Order Pharmacy, Suppliers / Managed Care Organization Pharmacy. Suppliers / Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy is the primary health care specialty. Mashantucket Pequot Tribal can be contacted via phone (860) 396-6438, or through Moldenhauer, Edward via phone (860) 396-2058.

Contact Information

Primary practice address
1 Annie George Dr Mashantucket CT 06338-3801
Phone: (860) 396-6438
Fax: (866) 396-6212
Website:
Map and Directions
Authorized official contact:
Name: Moldenhauer, Edward MS BS PHARM
Phone: (860) 396-2058

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy 332800000X ISH285960015 Connecticut
Suppliers / Pharmacy 333600000X
Suppliers / Mail Order Pharmacy 3336M0002X
Suppliers / Managed Care Organization Pharmacy 3336M0003X

Profile Details

NPI number 1003036435
LBN Legal business name Mashantucket Pequot Tribal
DBA Doing business as Pequot Health Care
Authorized official Moldenhauer, Edward MS BS PHARM
Entity Organization
Organization subpart 1 No
Enumeration date Apr 26th, 2007
Last updated Apr 1st, 2011 - about 14 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1003036435 NPPES
Connecticut MEDICAID 004129210
Connecticut Other 0718619

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