Type 2 · Organization ✓ Active NPI ✓ Valid NPI checksum Organization subpart

Mashantucket Pequot Tribal

Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy in Mashantucket, CT · enumerated 2006 · authorized official John Grossomanides, Director of Pharmacy Services.

Data current as of Jul 13, 2026 · sourced from CMS NPPES

National Provider Identifier

1720024524

Verified

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Registry record

Entity type Organization (Type 2)

Legal business name Mashantucket Pequot Tribal

Other name <Unavail>

Parent organization Mashantucket Pequot Tribal

Practice address 1 Annie George Drive, Bldg 1, Mashantucket, CT, 06338

Phone (860) 396-6435

Fax (800) 779-6329

Enumeration date Jun 21, 2006

Last updated in NPPES Apr 16, 2025

Taxonomy & classification

332800000X Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy Suppliers Primary

333600000X Pharmacy Suppliers Secondary

3336M0002X Mail Order Pharmacy Suppliers Secondary

Authorized official

Name John Grossomanides

Title Director of Pharmacy Services

Phone (860) 396-6435

Other identifiers

Identifier	Type	State	Issuer
004129210	Medicaid	CT	-
2000351	Other	-	PK

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 → Validate an NPI →

Frequently asked questions

Where is Mashantucket Pequot Tribal located?

The practice location on file with NPPES is in Mashantucket, CT.

How current is this record?

Data comes from the CMS NPPES public dissemination file; this record was last updated in NPPES on 2025-04-16. Verify at npiregistry.cms.hhs.gov.

Source: CMS NPPES (public data). Snapshot 2026-07-13. Provider record last updated 2025-04-16.