PEQUOT HEALTH CARE (MASHANTUCKET PEQUOT TRIBAL) NPI 1578886461

Pharmacy (Mail Order Pharmacy) in Mashantucket, CT

NPI 1578886461 Organization Pharmacy Mail Order Pharmacy

About PEQUOT HEALTH CARE (MASHANTUCKET PEQUOT TRIBAL)

Pequot Health Care (mashantucket Pequot Tribal) is a provider established in Mashantucket, Connecticut specializing in pharmacy (mail order pharmacy) . The NPI number of Pequot Health Care (mashantucket Pequot Tribal) is 1578886461 and was assigned on March 2010. The practitioner's primary taxonomy code is 3336M0002X with license number 285960015 (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 (Director Of Pharmacy Operation)

NPI

1578886461

Provider NamePEQUOT HEALTH CARE (MASHANTUCKET PEQUOT TRIBAL)
Provider Location Address1 ANNIE GEORGE DR BLDG 1 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 Date03-05-2010
Last Update Date04-01-2011


Primary Taxonomy

Taxonomy Code3336M0002X
ClassificationPharmacy
TypeSuppliers
SpecializationMail Order Pharmacy
License No.285960015
License StateCT
Taxonomy DescriptionA 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.

Business Address

PEQUOT HEALTH CARE
1 ANNIE GEORGE DR
BLDG 1
MASHANTUCKET, CT
ZIP 06338
Phone: (860) 396-6438
Fax: (800) 779-6329

Get Directions


Mailing Address

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



Authorized Official

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

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
004129210MEDICAID (05)CT
0721820OTHER (01)

Other Providers at the same location


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

NPI Name / Type Taxonomy Address
1003036435MASHANTUCKET PEQUOT TRIBAL
Organization
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy1 ANNIE GEORGE DR
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.