Individual
THEO BLAISE RUKUNDO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
850 HARRISON AVE STE BN27, BOSTON, MA 02118-4001
(857) 247-8763
Mailing address
850 HARRISON AVE STE BN27, BOSTON, MA 02118-4001
(857) 247-8763
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
PCT.0012736
CT
1835P0018X
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Primary
PH240122
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PCT.0012736
CONNECTICUT PHARMACIST LICENSE
CT
01
—
PH240122
MASSACHUSETTS PHARMACIST LICENSE
MA
Enumeration date
06/27/2014
Last updated
02/27/2023
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