MASHANTUCKET PEQUOT TRIBAL
NPI 1720024524
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy in Mashantucket, CT

NPI Status: Active since June 21, 2006

Contact Information

1 ANNIE GEORGE DRIVE
BLDG 1
MASHANTUCKET, CT
ZIP 06338
Phone: (860) 396-6435
Fax: (800) 779-6329

Get Directions Write a Review

  • Organization
  • Indian Health Service/Tribal/Urban India...
  • Accepts Insurance

About MASHANTUCKET PEQUOT TRIBAL

This page provides the complete NPI Profile along with additional information for Mashantucket Pequot Tribal, a provider established in Mashantucket, Connecticut operating as a Indian Health Service/tribal/urban Indian Health (i/t/u) Pharmacy. The healthcare provider is registered in the NPI registry with number 1720024524 assigned on June 2006. The practitioner's primary taxonomy code is 332800000X. The provider is registered as an organization and their NPI record was last updated one year ago. The provider's . The authorized official of this NPI record is Dr. John Grossomanides Pharmd, Rph (Director Of Pharmacy Services)

NPI
1720024524
Provider Legal Name
MASHANTUCKET PEQUOT TRIBAL
Other Organization Name
Other Name Type
(6)
Entity Type
Organization
Location Address
1 ANNIE GEORGE DRIVE BLDG 1 MASHANTUCKET, CT 06338
Location Phone
(860) 396-6435
Location Fax
(800) 779-6329
Mailing Address
1 ANNIE GEORGE DRIVE BLDG 1 MASHANTUCKET, CT 06338
Mailing Phone
(860) 396-6435
Mailing Fax
(800) 779-6329
Is Sole Proprietor?
No
Is Organization Subpart?
Yes
Enumeration Date
06-21-2006
Last Update Date
04-16-2025
Code Navigator

Location Map

Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification

Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy

Taxonomy Code
332800000X
Type
Suppliers
Taxonomy Description
An 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.

Secondary Taxonomies

The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.

No. Taxonomy Code Type Classification /
Specialization
License No. (State)
1333600000XSuppliers

Pharmacy

 
23336M0002XSuppliers

Pharmacy
Mail Order Pharmacy

 

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

  • BSW Diabetes Care Gold HMO 014 - HMO
  • BSW Elite Gold HMO 001 (CMS Standardized Plan with $0 Pediatric PCP copay) - HMO
  • BSW Elite Gold HMO 004 - HMO
  • BSW Elite Gold HMO 012 - HMO
  • BSW Prime Silver HMO 003 (CMS Standardized Plan with $0 Pediatric PCP copay) - HMO
  • BSW Prime Silver HMO 008 - HMO
  • BSW Prime Silver HMO 005 - HMO
  • BSW Savers Bronze HMO H S A 006 - HMO
  • BSW Savers Bronze HMO H S A 007 (CMS Standardized Plan with $0 Pediatric PCP copay) - HMO
  • BSW Savers Bronze HMO H S A 009 - HMO

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name

DR. JOHN GROSSOMANIDES PHARMD, RPH

Authorized Official Title
DIRECTOR OF PHARMACY SERVICES
Authorized Official Phone
(860) 396-6435

Additional Identifiers

The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State Identifier Issuer
004129210MEDICAID (05)CT 
2000351OTHER (01)PK

Reviews for MASHANTUCKET PEQUOT TRIBAL

There are currently no reviews for this provider. Be the first person to share your experience with this provider by filling out our review form. Your insights are appreciated and will help others make informed decisions.

NPI NPI Number Validation

How NPI Validation Works

The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.

To verify the NPI 1720024524, we treat the final digit (4) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 56. The final step is to find the difference between that total and the next multiple of ten (60 - 56 = 4).

Digit-by-digit view

Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.

Pos 1
1
Doubled → 2
Pos 2
7
Unchanged
Pos 3
2
Doubled → 4
Pos 4
0
Unchanged
Pos 5
0
Doubled → 0
Pos 6
2
Unchanged
Pos 7
4
Doubled → 8
Pos 8
5
Unchanged
Pos 9
2
Doubled → 4
Check
4
Target digit
Regular digit Doubled digit Check digit

Step 1: Double every other digit from the right

Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.

1 → 2 2 → 4 0 → 0 4 → 8 2 → 4

Step 2: Add all digits plus the NPI constant

Add the transformed values, the unchanged digits, and the constant 24.

2 + 7 + 4 + 0 + 0 + 2 + 8 + 5 + 4 + 24 = 56

Step 3: Find the amount needed to reach the next multiple of 10

The next multiple of ten after 56 is 60. The difference is the calculated check digit.

60 - 56 = 4
This NPI is valid
The calculated check digit is 4, which matches the last digit of 1720024524.

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1720024524, enumerated as an "organization" on June 21, 2006.

The provider is located at 1 ANNIE GEORGE DRIVE BLDG 1 MASHANTUCKET, CT 06338 and the phone number is (860) 396-6435.

Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy with taxonomy code 332800000X.

The provider might be accepting Accepts: Baylor Scott and White Health Plan, Medicare and. Please consult your insurance carrier or call the provider to verify.