Healthcare Provider Details

I. General information

NPI: 1376176735
Provider Name (Legal Business Name): BPTN INVESTMENT SERIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2020
Last Update Date: 02/13/2020
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7025 FRY RD STE 400
CYPRESS TX
77433-8152
US

IV. Provider business mailing address

17515 SPRING CYPRESS RD # 256
CYPRESS TX
77429-2688
US

V. Phone/Fax

Practice location:
  • Phone: 888-300-8743
  • Fax: 888-512-6266
Mailing address:
  • Phone: 888-300-8743
  • Fax: 888-512-6266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. BRYAN THANH PHAN
Title or Position: MEMBER MANAGED
Credential: RPH
Phone: 408-661-3881