Grand Canyon Lab LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

GRAND CANYON LAB LLC

Practice address

4141 N 32ND St Ste 102
Phoenix, AZ 85018-4775

Phone

(857) 247-8763

NPI assigned

Apr 10, 2023

Organization subpart

No

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

Authorized official

Name

Dr. Theo Blaise Rukundo, PHARMD, MBANPI 1215342209

Title

Managing Director

Phone

(857) 247-8763

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Theo Blaise Rukundo, PHARMD

  • Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
  • Boston, MA
  • NPI 1215342209
  NPD Authorized official

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

{
    "created_epoch": "1681084800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681084800000",
    "number": "1134814874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4141 N 32ND ST STE 102",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850184775",
            "telephone_number": "857-247-8763"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4141 N 32ND ST STE 102",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850184775",
            "telephone_number": "857-247-8763"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND CANYON LAB LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-10",
        "last_updated": "2023-04-10",
        "certification_date": "2023-04-08",
        "status": "A",
        "authorized_official_last_name": "RUKUNDO",
        "authorized_official_first_name": "THEO",
        "authorized_official_middle_name": "BLAISE",
        "authorized_official_title_or_position": "MANAGING DIRECTOR",
        "authorized_official_telephone_number": "857-247-8763",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARMD, MBA"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Grand Canyon Home Health Care, Inc.
• Grand Canyon University
• Grand Canyon Wellness Center
• Grand Desert Home Health, LLC
• Grand Services and More LLC
• Grand Therapy LTD

• Clinical Medical Laboratory in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Clinical Medical Laboratory in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2023; 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.