Mashantucket Pequot Tribal
NPI #1003036435 in Mashantucket, Connecticut
Provider Information
- NPI Number
- 1003036435
- Entity Type
- Organization
- Organization Name
- Mashantucket Pequot Tribal
- Primary Specialty
- Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
- Enumeration Date
- Apr 26, 2007
- Last Updated
- Apr 1, 2011
Practice Location
- Address
- 1 ANNIE GEORGE DR
- City
- Mashantucket
- State
- Connecticut
- ZIP Code
- 06338-3801
- Phone
- (860) 396-6438
Authorized Official
- Name
- EDWARD MOLDENHAUER, MS BS PHARM
- Title
- DIRECTOR OF PHARMACY OPERATION
- Phone
- (860) 396-2058
Specialties & Taxonomy Codes
| Specialty |
|---|
| Pharmacy - Mail Order Pharmacy — Mail Order Pharmacy |
| Pharmacy - Managed Care Organization Pharmacy — Managed Care Organization Pharmacy |
| Pharmacy |
| Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy |
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|---|---|
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