PEQUOT HEALTH CARE (MASHANTUCKET PEQUOT TRIBAL) NPI 1003036435

Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy in Mashantucket, CT

NPI 1003036435 Organization Indian Health Service/Tribal/Urban India...

About PEQUOT HEALTH CARE (MASHANTUCKET PEQUOT TRIBAL)

Pequot Health Care (mashantucket Pequot Tribal) is a provider established in Mashantucket, Connecticut specializing in indian health service/tribal/urban indian health (i/t/u) pharmacy. The NPI number of Pequot Health Care (mashantucket Pequot Tribal) is 1003036435 and was assigned on April 2007. The practitioner's primary taxonomy code is 332800000X with license number ISH285960015 (CT). The provider is registered as an organization and their NPI record was last updated 11 years ago. The provider's is doing business as Pequot Health Care. The authorized official of this NPI record is Edward Moldenhauer Ms Bs Pharm (Director Of Pharmacy Operation)

NPI

1003036435

Provider NamePEQUOT HEALTH CARE (MASHANTUCKET PEQUOT TRIBAL)
Provider Location Address1 ANNIE GEORGE DR MASHANTUCKET, CT 06338
Provider Mailing Address1 ANNIE GEORGE DR PO BOX 3559 MASHANTUCKET, CT 06338
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Other Organization NamePEQUOT HEALTH CARE
Other Name TypeDoing Business As (3)
Enumeration Date04-26-2007
Last Update Date04-01-2011


Primary Taxonomy

Taxonomy Code332800000X
ClassificationIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
TypeSuppliers
License No.ISH285960015
License StateCT
Taxonomy DescriptionAn Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy means a pharmacy operated by the Indian Health Service, an Indian tribe or tribal organization, or an urban Indian organization, all of which are defined in Section 4 of the Indian Health Care Improvement Act, 25 U.S.C. 1603.

Business Address

PEQUOT HEALTH CARE
1 ANNIE GEORGE DR
MASHANTUCKET, CT
ZIP 06338
Phone: (860) 396-6438
Fax: (866) 396-6212

Get Directions


Mailing Address

PEQUOT HEALTH CARE
1 ANNIE GEORGE DR
PO BOX 3559
MASHANTUCKET, CT
ZIP 06338
Phone: (860) 369-2058
Fax: (860) 396-6212



Authorized Official

Authorized Official Name EDWARD MOLDENHAUER MS BS PHARM
Authorized Official TitleDIRECTOR OF PHARMACY OPERATION
Authorized Official Phone(860) 396-2058

Secondary Taxonomies


The secondary taxonomy codes define the provider type, classification, and specialization. For individual NPIs the license data is associated to each taxonomy code.

No. Taxonomy Code Type Classification Specialization License No. State Primary
1333600000XSuppliersPharmacyNo

Taxonomy Description: a facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

23336M0002XSuppliersPharmacyMail Order PharmacyNo

Taxonomy Description: a pharmacy where pharmacists compound or dispense prescriptions or other medications in accordance with federal and state law, using common carriers to deliver the medications to patient or their caregivers. Mail order pharmacies counsel patients and caregivers (sometimes independent of the dispensing process) through telephone or email contact and provide other professional services associated with pharmaceutical care appropriate to the setting. Mail order pharmacies are licensed as a Mail Order Pharmacy in the state where they are located and may also be licensed or registered as nonresident pharmacies in other states.

33336M0003XSuppliersPharmacyManaged Care Organization PharmacyNo

Taxonomy Description: a pharmacy owned by a managed care organization (MCO) used by pharmacists for the compounding and dispensing of medicinal preparations to that MCO's covered members only.

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
0718619OTHER (01)
004129210MEDICAID (05)CT

Other Providers at the same location


The following 10 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1578886461MASHANTUCKET PEQUOT TRIBAL
Organization
Pharmacy (Mail Order Pharmacy)1 ANNIE GEORGE DR BLDG 1
MASHANTUCKET, CT 06338
(860) 396-6438
1487978177MRS. AMY D RICUPERO RPH, MED
Individual
Pharmacist1 ANNIE GEORGE DR
MASHANTUCKET, CT 06338
(888) 779-6362
1639480163 CATHERINE ANN KOIVISTO RPH
Individual
Pharmacist1 ANNIE GEORGE DR
MASHANTUCKET, CT 06338
(888) 779-6362
1407166846 TIMOTHY J POOLE PHARMD
Individual
Pharmacist1 ANNIE GEORGE DR
MASHANTUCKET, CT 06338
(888) 779-6362
1285912808 JENNIFER MCCUE RPH
Individual
Pharmacist1 ANNIE GEORGE DR BLDG 1
MASHANTUCKET, CT 06338
(860) 396-6438
1538445747 IAN PARNIGONI PHARMD.
Individual
Pharmacist1 ANNIE GEORGE DR
MASHANTUCKET, CT 06338
(888) 779-6362
1831559855 MILLIE WHITE
Individual
Pharmacist1 ANNIE GEORGE DR
MASHANTUCKET, CT 06338
(888) 779-6362
1053772657 CAROL LEA OURS RPH, AEC
Individual
Pharmacist1 ANNIE GEORGE DR
MASHANTUCKET, CT 06338
(888) 779-6362
1891156493 CARLA O'DONNELL RPH
Individual
Pharmacist1 ANNIE GEORGE DR
MASHANTUCKET, CT 06338
(860) 396-6430
1720024524MASHANTUCKET PEQUOT TRIBAL
Organization
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy1 ANNIE GEORGE DR BLDG 1
MASHANTUCKET, CT 06338
(860) 396-6438

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.