=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356671689
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LYNN OAKS COMPOUNDING PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2010
-----------------------------------------------------
Last Update Date | 01/08/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2220 LYNN RD STE 100
-----------------------------------------------------
City | THOUSAND OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91360-8044
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-495-1015
-----------------------------------------------------
Fax | 805-496-8492
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2220 LYNN RD STE 100
-----------------------------------------------------
City | THOUSAND OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91360-8044
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-495-1015
-----------------------------------------------------
Fax | 805-496-8492
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. SHIRLEY POON
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 805-495-1015
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 61723
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------