NPI 1720024524
Mashantucket Pequot Tribal
Practice location
- Address
- 1 Annie George Drive Bldg 1, Mashantucket, CT 06338-3801
- Phone
- (860) 396-6435
- Fax
- (800) 779-6329
Authorised official
- Name
- John Grossomanides
- Title
- Director of Pharmacy Services
- Phone
- (860) 396-6435
Registered specialties (3)
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Primary
Mail Order Pharmacy
Registry record
- NPI
- 1720024524
- Entity type
- Organization
- NPI issued
- 21 Jun 2006
- Record last updated
- 16 Apr 2025
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.