Mashantucket Pequot Tribal
Indian Health Service/tribal/urban Indian Health (i/t/u) Pharmacy
1 Annie George Dr, Mashantucket
Connecticut, 06338-3801
860-396-6438 866-396-6212
Mashantucket Pequot Tribal is a Indian Health Service/tribal/urban Indian Health (i/t/u) Pharmacy in Mashantucket, Connecticut. It is located at 1 Annie George Dr, Mashantucket and it's customer support contact number is 860-396-6438. The authorized person of Mashantucket Pequot Tribal is Edward Moldenhauer, MS BS PHARM who is Director Of Pharmacy Operation of the pharmacy and his contact number is 860-396-2058. Active license number of Mashantucket Pequot Tribal is ISH285960015 for Indian Health Service/tribal/urban Indian Health (i/t/u) Pharmacy in Connecticut.
Mashantucket Pequot Tribal is 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.
Pharmacy Details:
Mashantucket Pequot Tribal type, location, contact phone number and fax are as below. Patients can directly walkin to the pharmacy or can call on the below given customer support phone number for enquiries.
| Name: | Mashantucket Pequot Tribal |
| Type: | Indian Health Service/tribal/urban Indian Health (i/t/u) Pharmacy |
| Location: | 1 Annie George Dr, Mashantucket,
Connecticut, 06338-3801 |
| Phone: | 860-396-6438 |
| Fax: | 866-396-6212 |
Authorized/Official Person Profile:
Officially authorized person to contact for any management issues or complaints of this pharmacy is as below. Person's position and contact details are also mentioned below.
| Name: | Edward Moldenhauer |
| Credentials: | MS BS PHARM |
| Position: | Director Of Pharmacy Operation |
| Contact Number: | 860-396-2058 |
Professional Identification Codes:
NPI number stands for National Provider Identifier which is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS).
NPI details of given pharmacy are as mentioned below.
| NPI Number: | 1003036435 |
| NPI Enumeration Date: | 26 Apr, 2007 |
| NPI Last Update On: | 01 Apr, 2011 |
Medical Licenses:
Organizations can have one or more medical licenses for different specialities in the same state or different states. Related medical licenses for Mashantucket Pequot Tribal are as mentioned below.
| Specialization | License Number | State | Status | |
| Indian Health Service/tribal/urban Indian Health (i/t/u) Pharmacy | ISH285960015 | Connecticut | Primary | |
| Mail Order Pharmacy | | | Secondary | |
| Managed Care Organization Pharmacy | | | Secondary | |
| Pharmacy | | | Secondary | |
Other Medical Identifiers:
Other legacy medical identifiers of the pharmacy such as Medicaid, Medicare PIN, NSC, UPIN etc. are mentioned as below.
| Identifier | Type | State | Issuer |
| 004129210 | Medicaid | Connecticut | |
| 0718619 | Other | | Ncpdp Provider Identification Number |
Business Mailing Address:
Business mailing address can be used for mailing purpose only, for visiting purpose patients need to refer above mentioned address.
| Address: | 1 Annie George Dr, Po Box 3559
Mashantucket, Connecticut |
| Zip: | 06338-3801 |
| Phone Number: | 860-369-2058 |
| Fax Number: | 860-396-6212 |
Patients can reach Mashantucket Pequot Tribal at
1 Annie George Dr, Mashantucket, Connecticut or can
call on customer care at 860-396-6438.
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**Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES. Last updated on 08 December, 2025.