Theo Blaise Rukundo, PHARMD

Primary specialty

Pharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistTaxonomy code 1835P0018X

License

PH240122 Issued in MA

Practice address

850 Harrison Ave Ste BN27
Boston, MA 02118-4001

Phone

(857) 247-8763

NPI assigned

Jun 27, 2014

Last updated

Feb 27, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Asante Pharmacy LLC

  • Community/Retail Pharmacy
  • Surprise, AZ
  • NPI 1710672456
  NPD Authorized official
• Grand Canyon Lab LLC

  • Clinical Medical Laboratory
  • Phoenix, AZ
  • NPI 1134814874
  NPD Authorized official
• Walgreen Co

  dba Walgreens #21605

  • Pharmacy
  • Longview, TX
  • NPI 1629956545
  NPD (past)
• Walgreen Co

  dba Walgreens #05948

  • Pharmacy
  • Meriden, CT
  • NPI 1891700142
  NPD (past)

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

{
    "created_epoch": "1403827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677456000000",
    "number": "1215342209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "850 HARRISON AVE STE BN27",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021184001",
            "telephone_number": "857-247-8763"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 HARRISON AVE STE BN27",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021184001",
            "telephone_number": "857-247-8763"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUKUNDO",
        "first_name": "THEO",
        "middle_name": "BLAISE",
        "credential": "PHARMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-06-27",
        "last_updated": "2023-02-27",
        "certification_date": "2023-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "CT",
            "license": "PCT.0012736",
            "primary": false
        },
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "MA",
            "license": "PH240122",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CONNECTICUT PHARMACIST LICENSE",
            "identifier": "PCT.0012736",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MASSACHUSETTS PHARMACIST LICENSE",
            "identifier": "PH240122",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer L Ruiz, M.D.
• Joseph Ruiz, MD
• Juan Pablo Ruiz, MD
• Virginia Ruiz, MD
• Tara Marie Rukstalis, N.P.
• Laurie Rumker, MD, PHD
• Sarah Rumshiskaya
• Kyle Rundles, PSYD
• Christopher Runey, N.P.
• Katherine Elaine Runey, NP

• Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Boston, MA
• Providers in Boston, MA by specialty
• Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 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.