Provider Demographics
NPI:1710672456
Name:ASANTE PHARMACY LLC
Entity Type:Organization
Organization Name:ASANTE PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THEO
Authorized Official - Middle Name:BLAISE
Authorized Official - Last Name:RUKUNDO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, MBA
Authorized Official - Phone:857-247-8763
Mailing Address - Street 1:16960 W BELL RD
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-8937
Mailing Address - Country:US
Mailing Address - Phone:857-247-8763
Mailing Address - Fax:
Practice Address - Street 1:16960 W BELL RD
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-8937
Practice Address - Country:US
Practice Address - Phone:602-900-3506
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy