Healthcare Provider Details

I. General information

NPI: 1164433744
Provider Name (Legal Business Name): TOWNSGATE ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 08/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 TOWNSGATE RD STE 117
WESTLAKE VILLAGE CA
91361-3001
US

IV. Provider business mailing address

2900 TOWNSGATE RD STE 117
WESTLAKE VILLAGE CA
91316-3001
US

V. Phone/Fax

Practice location:
  • Phone: 805-778-9272
  • Fax: 805-778-0179
Mailing address:
  • Phone: 805-778-9272
  • Fax: 805-778-0179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHY17251
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY49027
License Number StateCA

VIII. Authorized Official

Name: TATYANA FALLS
Title or Position: MANAGER
Credential:
Phone: 818-505-6566