Mashantucket Pequot Tribal
Mashantucket Pequot Tribal is a healthcare organization registered as Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy in Mashantucket, CT, holding Type 2 (organization) NPI 1003036435 since 2007. The authorized official on file is Edward Moldenhauer, Director of Pharmacy Operation.
✓ Active NPI ✓ Valid NPI checksum
| NPI | 1003036435 |
|---|---|
| Entity type | Organization (Type 2) |
| Legal business name | Mashantucket Pequot Tribal |
| Other name | <Unavail> |
| Practice address | 1 ANNIE GEORGE DR, Mashantucket, CT, 06338 |
| Phone | 8603966438 |
| Fax | 8663966212 |
| Enumeration date | 2007-04-26 |
| Last updated in NPPES | 2011-04-01 |
Authorized official
| Name | Edward Moldenhauer |
|---|---|
| Title | Director of Pharmacy Operation |
| Phone | 8603962058 |
Taxonomy & classification
| Taxonomy code | Specialty | Primary | License | State |
|---|---|---|---|---|
| 3336M0002X | Mail Order Pharmacy | Secondary | — | — |
| 3336M0003X | Managed Care Organization Pharmacy | Secondary | — | — |
| 333600000X | Pharmacy | Secondary | — | — |
| 332800000X | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | Primary | ISH285960015 | CT |
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 004129210 | Medicaid | CT | — |
| 0718619 | Other | — | NCPDP PROVIDER IDENTIFICATION NUMBER |
Copy-ready billing details
Provider: Mashantucket Pequot Tribal NPI: 1003036435 Taxonomy: 332800000X (Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy) Address: 1 ANNIE GEORGE DR, Mashantucket, CT, 06338
Providers at this address
| NPI | Name | Type | Specialty | Location |
|---|---|---|---|---|
| 1578886461 | Mashantucket Pequot Tribal | Organization | Mail Order Pharmacy | Mashantucket, CT |
| 1487978177 | Amy Ricupero | Individual | Pharmacist | Mashantucket, CT |
| 1639480163 | Catherine Koivisto | Individual | Pharmacist | Mashantucket, CT |
| 1407166846 | Timothy Poole | Individual | Pharmacist | Mashantucket, CT |
| 1285912808 | Jennifer Mccue | Individual | Pharmacist | Mashantucket, CT |
| 1831559855 | Millie White | Individual | Pharmacist | Mashantucket, CT |
| 1053772657 | Carol Lea Ours | Individual | Pharmacist | Mashantucket, CT |
| 1891156493 | Carla O'Donnell | Individual | Pharmacist | Mashantucket, CT |
Verify this record
Cross-check NPI 1003036435 against the authoritative CMS record: view Mashantucket Pequot Tribal on the official NPPES registry .
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes — even if the provider moves or changes specialty. Read the full guide or validate an NPI number.
Frequently asked questions
Who is the authorized official for Mashantucket Pequot Tribal?
What is the NPI number for Mashantucket Pequot Tribal?
Source: CMS NPPES (public data). Snapshot 2026-07-10. Provider record last updated 2011-04-01.