NPI 1003036435
Mashantucket Pequot Tribal
Practice location
- Address
- 1 Annie George Dr, Mashantucket, CT 06338-3801
- Phone
- (860) 396-6438
- Fax
- (866) 396-6212
- Mailing address
- 1 Annie George Dr PO Box 3559, Mashantucket, CT 06338-3801
Authorised official
- Name
- Edward Moldenhauer
- Title
- Director of Pharmacy Operation
- Phone
- (860) 396-2058
Registered specialties (4)
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Primary
Mail Order Pharmacy
Managed Care Organization Pharmacy
Registry record
- NPI
- 1003036435
- Entity type
- Organization
- NPI issued
- 26 Apr 2007
- Record last updated
- 1 Apr 2011
Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.