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 1720024524 since 2006. The authorized official on file is John Grossomanides, Director of Pharmacy Services.

✓ Active NPI ✓ Valid NPI checksum Organization subpart

NPI	1720024524
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	8603966435
Fax	8007796329
Enumeration date	2006-06-21
Last updated in NPPES	2025-04-16

Authorized official

Name	John Grossomanides
Title	Director of Pharmacy Services
Phone	8603966435

Taxonomy & classification

Taxonomy code	Specialty	Primary	License	State
333600000X	Pharmacy	Secondary	—	—
3336M0002X	Mail Order Pharmacy	Secondary	—	—
332800000X	Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy	Primary	—	—

Other identifiers

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

Copy-ready billing details

Provider: Mashantucket Pequot Tribal
NPI: 1720024524
Taxonomy: 332800000X (Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy)
Address: 1 ANNIE GEORGE DRIVE, BLDG 1, Mashantucket, CT, 06338

Verify this record

Cross-check NPI 1720024524 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

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 2026-07-11. Provider record last updated 2025-04-16.