Provider Demographics
NPI:1225051733
Name:PHAN, BRYAN THANH
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:THANH
Last Name:PHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6609 W SAM HOUSTON PKWY S STE 98B
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77072-1641
Mailing Address - Country:US
Mailing Address - Phone:713-995-8885
Mailing Address - Fax:713-776-9990
Practice Address - Street 1:6609 W SAM HOUSTON PKWY S STE 98B
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77072-1641
Practice Address - Country:US
Practice Address - Phone:713-995-8885
Practice Address - Fax:713-776-9990
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH570941835P0018X, 1835P1200X
TX51263183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy