Provider Demographics
NPI:1003343013
Name:BVN CREATIVE CARE, INC. DBA- COLDSPRING PHARMACY
Entity Type:Organization
Organization Name:BVN CREATIVE CARE, INC. DBA- COLDSPRING PHARMACY
Other - Org Name:COLDSPRING PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JERMAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-303-3189
Mailing Address - Street 1:P.O. BOX 2188
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77410
Mailing Address - Country:US
Mailing Address - Phone:713-303-3189
Mailing Address - Fax:281-593-2928
Practice Address - Street 1:13325 HARGRAVE ROAD
Practice Address - Street 2:SUITE 230A
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070
Practice Address - Country:US
Practice Address - Phone:281-888-0222
Practice Address - Fax:844-732-7187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-22
Last Update Date:2021-03-11
Deactivation Date:2020-10-20
Deactivation Code:
Reactivation Date:2021-02-01
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX314083336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2169487OtherPK