Mohegan Tribe of Indians of CT

Primary specialty

Indian Health Service/Tribal/Urban Indian Health (I/T/U) PharmacyTaxonomy code 332800000X

License

114286 Issued in AL

Legal business name

MOHEGAN TRIBE OF INDIANS OF CT

Doing business as

Mohegan Pharmacy

Practice address

67 Sandy Desert Rd
Uncasville, CT 06382-1111

Phone

(855) 664-4679

Fax

(860) 862-9099

NPI assigned

Mar 20, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Debra Maxeiner

Title

Deputy Chief of Staff, Ops&Admin

Phone

(860) 862-6343

Specialties & licenses 15

Addresses

Other identifiers 1

Other names 1

• Mohegan Pharmacy Doing business as

Tax ID family

Mohegan Pharmacy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Mohegan Tribe of Indians of Connecticut

  • Ambulance
  • Uncasville, CT
  • NPI 1467442863
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Khristine S Lariviere, RPH

  • Pharmacist
  • Uncasville, CT
  • NPI 1912273194
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1332201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560816000000",
    "number": "1326313677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "67 SANDY DESERT RD",
            "city": "UNCASVILLE",
            "state": "CT",
            "postal_code": "063821111",
            "telephone_number": "855-664-4679",
            "fax_number": "860-862-9099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "67 SANDY DESERT RD",
            "city": "UNCASVILLE",
            "state": "CT",
            "postal_code": "063821111",
            "telephone_number": "855-664-4679",
            "fax_number": "860-862-9099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOHEGAN TRIBE OF INDIANS OF CT",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-20",
        "last_updated": "2019-06-18",
        "status": "A",
        "authorized_official_last_name": "MAXEINER",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_title_or_position": "DEPUTY CHIEF OF STAFF, OPS&ADMIN",
        "authorized_official_telephone_number": "860-862-6343"
    },
    "taxonomies": [
        {
            "code": "332800000X",
            "taxonomy_group": "",
            "desc": "Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy",
            "state": "CT",
            "license": "PCY.0001934",
            "primary": false
        },
        {
            "code": "332800000X",
            "taxonomy_group": "",
            "desc": "Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy",
            "state": "KS",
            "license": "22-102271",
            "primary": false
        },
        {
            "code": "332800000X",
            "taxonomy_group": "",
            "desc": "Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy",
            "state": "DC",
            "license": "NRX0000432",
            "primary": false
        },
        {
            "code": "332800000X",
            "taxonomy_group": "",
            "desc": "Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy",
            "state": "CO",
            "license": "OSP.0006230",
            "primary": false
        },
        {
            "code": "332800000X",
            "taxonomy_group": "",
            "desc": "Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy",
            "state": "MO",
            "license": "2013044792",
            "primary": false
        },
        {
            "code": "332800000X",
            "taxonomy_group": "",
            "desc": "Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy",
            "state": "MS",
            "license": "14964/7.1",
            "primary": false
        },
        {
            "code": "332800000X",
            "taxonomy_group": "",
            "desc": "Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy",
            "state": "LA",
            "license": "PHY.007550-NR",
            "primary": false
        },
        {
            "code": "332800000X",
            "taxonomy_group": "",
            "desc": "Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy",
            "state": "GA",
            "license": "PHNR001180",
            "primary": false
        },
        {
            "code": "332800000X",
            "taxonomy_group": "",
            "desc": "Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy",
            "state": "FL",
            "license": "PH26952",
            "primary": false
        },
        {
            "code": "332800000X",
            "taxonomy_group": "",
            "desc": "Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy",
            "state": "AL",
            "license": "114286",
            "primary": true
        },
        {
            "code": "332800000X",
            "taxonomy_group": "",
            "desc": "Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy",
            "state": "IL",
            "license": "54.018477",
            "primary": false
        },
        {
            "code": "332800000X",
            "taxonomy_group": "",
            "desc": "Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy",
            "state": "MT",
            "license": "PHA-MOP-LIC-25328",
            "primary": false
        },
        {
            "code": "332800000X",
            "taxonomy_group": "",
            "desc": "Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy",
            "state": "HI",
            "license": "PMP-959",
            "primary": false
        },
        {
            "code": "332800000X",
            "taxonomy_group": "",
            "desc": "Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy",
            "state": "CA",
            "license": "NRP-1530",
            "primary": false
        },
        {
            "code": "332800000X",
            "taxonomy_group": "",
            "desc": "Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy",
            "state": "ME",
            "license": "MO40001384",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2135247",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mohegan Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mohegan Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jessica McKeever, CCC-SLP
• Timothy McKenna, PHARMD
• Bethany Luciani Miller, PA-C
• MLM Chiropractic LLC
• Mohegan Tribe of Indians of Connecticut
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• Carolyn Moody
• Paqui D Motyl, MD
• Murphy Chiropractic LLC
• Michael Lee Murphy, D.C.

• Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy in Uncasville, CT
• Providers in Uncasville, CT by specialty
• Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.