Healthcare Provider Details

I. General information

NPI: 1710672456
Provider Name (Legal Business Name): ASANTE PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 04/10/2023
Certification Date: 04/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16960 W BELL RD
SURPRISE AZ
85374-8937
US

IV. Provider business mailing address

16960 W BELL RD
SURPRISE AZ
85374-8937
US

V. Phone/Fax

Practice location:
  • Phone: 602-900-3506
  • Fax:
Mailing address:
  • Phone: 857-247-8763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. THEO BLAISE RUKUNDO
Title or Position: MANAGING DIRECTOR
Credential: PHARMD, MBA
Phone: 857-247-8763