=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164433744
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TOWNSGATE ENTERPRISES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2006
-----------------------------------------------------
Last Update Date | 08/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2900 TOWNSGATE RD STE 117
-----------------------------------------------------
City | WESTLAKE VILLAGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91361-3001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-778-9272
-----------------------------------------------------
Fax | 805-778-0179
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2900 TOWNSGATE RD STE 117
-----------------------------------------------------
City | WESTLAKE VILLAGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91316-3001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-778-9272
-----------------------------------------------------
Fax | 805-778-0179
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | TATYANA FALLS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-505-6566
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PHY49027
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | PHY17251
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------