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

Active since June 21, 2006
1 ANNIE GEORGE DRIVE, BLDG 1, MASHANTUCKET, CT 06338(860) 396-6435(800) 779-6329 Get Directions Write a Review

NPPES record last updated: April 16, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Mashantucket Pequot Tribal NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MASHANTUCKET PEQUOT TRIBAL (NPI 1720024524), doing business as Pequot Health Care, is a healthcare organization registered as an indian health service/tribal/urban indian health (i/t/u) pharmacy in Mashantucket, Connecticut and active in the NPI registry since June 2006. The organization lists John Grossomanides, Director Of Pharmacy Services, as its authorized official.

NPPES Registry Identity

NPI1720024524
Entity TypeOrganization
Primary Taxonomy332800000X
Legal Business NameMASHANTUCKET PEQUOT TRIBAL
Location Address1 ANNIE GEORGE DRIVE, BLDG 1Mashantucket, CT 06338-3801
Mailing Address1 Annie George Drive, Bldg 1Mashantucket, CT 06338-3801 · (860) 396-6435 · Fax (860) 396-6212
Phone(860) 396-6435
Fax(800) 779-6329
Organization SubpartYes
Authorized OfficialJohn GrossomanidesDirector Of Pharmacy Services · (860) 396-6435
Enumeration DateJune 21, 2006
Last NPPES UpdateApril 16, 2025
✔ NPI 1720024524 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyIndian Health Service/Tribal/Urban Indian Health (I/T/U) PharmacySuppliers
Taxonomy Code332800000X
Definition
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.
Also ListedPharmacyTaxonomy 333600000X
Also ListedPharmacy · Mail Order PharmacyTaxonomy 3336M0002X
1 ANNIE GEORGE DRIVE, Mashantucket, CT 06338
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Other Names 1

Doing Business AsPequot Health Care

Other Identifiers 2

Medicaid004129210CT
Other2000351Pk

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Baylor Scott and White Health Plan.Insurance ›

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mashantucket Pequot Tribal's NPI number?

The NPI number for Mashantucket Pequot Tribal is 1720024524. It was assigned to this organization in the NPPES registry on June 21, 2006. The provider is doing business as Pequot Health Care.

Where is Mashantucket Pequot Tribal located?

Mashantucket Pequot Tribal is located at 1 Annie George Drive Bldg 1, Mashantucket, CT 06338. The listed phone number is (860) 396-6435.

What is Mashantucket Pequot Tribal's specialty?

The primary specialty registered for this NPI is Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy with taxonomy code 332800000X.

What insurance does Mashantucket Pequot Tribal accept?

Health plans from Baylor Scott and White Health Plan list Mashantucket Pequot Tribal as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Mashantucket Pequot Tribal was last updated on April 16, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.