Pequot Health Care

LBN: Mashantucket Pequot Tribal
Pequot Health Care is an health care organization with primary practice located at 1 Annie George Dr Bldg 1, Mashantucket CT 06338-3801. The organization recently has 3 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 / 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 Bldg 1 Mashantucket CT 06338-3801
Phone: (860) 396-6438
Fax: (800) 779-6329
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
Suppliers / Pharmacy 333600000X
Suppliers / Mail Order Pharmacy 3336M0002X

Profile Details

NPI number 1720024524
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 Jun 21st, 2006
Last updated Oct 6th, 2016 - about 10 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 1720024524 NPPES
Connecticut MEDICAID 004129210
Connecticut Other 2000351

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