Organization
MOHEGAN TRIBE OF INDIANS OF CT
Active
Other names
Mohegan Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DEBRA MAXEINER (DEPUTY CHIEF OF STAFF, OPS&ADMIN)
(860) 862-6343
Entity
Organization
Contact information
Practice address
67 SANDY DESERT RD, UNCASVILLE, CT 06382-1111
(855) 664-4679
(860) 862-9099
Mailing address
67 SANDY DESERT RD, UNCASVILLE, CT 06382-1111
(855) 664-4679
(860) 862-9099
Taxonomy
Speciality
Code
Description
License number
State
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Primary
114286
AL
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
14964/7.1
MS
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
2013044792
MO
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
22-102271
KS
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
54.018477
IL
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
MO40001384
ME
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
NRP-1530
CA
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
NRX0000432
DC
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
OSP.0006230
CO
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
PCY.0001934
CT
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
PH26952
FL
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
PHA-MOP-LIC-25328
MT
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
PHNR001180
GA
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
PHY.007550-NR
LA
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
PMP-959
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2135247
PK
—
Enumeration date
03/20/2012
Last updated
06/18/2019
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