National Provider Identifier Database

MOHEGAN TRIBE OF INDIANS OF CT
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy

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.


Contact Information

MOHEGAN TRIBE OF INDIANS OF CT
67 SANDY DESERT RD
UNCASVILLE, CT06382-1111
Phone: 855-664-4679
Fax: 860-862-9099
Website:
Specialty Taxonomy Code
* Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy 332800000X

* Indicates primary specialty

NPI Profile & details for MOHEGAN TRIBE OF INDIANS OF CT

NPI Number 1326313677
Legal business name
LBN
MOHEGAN TRIBE OF INDIANS OF CT
Authorized official DEBRA MAXEINER - (DEPUTY CHIEF OF STAFF, OPS&ADMIN)
Entity Organization
Organization subpart No
Enumeration date 03/20/2012
Last updated 06/18/2019 - About 7 years ago
Sole proprietor1 Not specified
Identifiers
  • AL License #: 114286
  • CA License #: NRP-1530
  • CO License #: OSP.0006230
  • CT License #: PCY.0001934
  • DC License #: NRX0000432
  • FL License #: PH26952
  • GA License #: PHNR001180
  • HI License #: PMP-959
  • IL License #: 54.018477
  • KS License #: 22-102271
  • LA License #: PHY.007550-NR
  • ME License #: MO40001384
  • MO License #: 2013044792
  • MS License #: 14964/7.1
  • MT License #: PHA-MOP-LIC-25328
  • Other: 2135247 PK

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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