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Organization
LUCKY STORES II LLC
Active
Organization
LUCKY STORES II LLC
Active
Other names
SAVON DRUGS
Organization subpart
No
Provider details
NPI number
Authorized official
LORENZO TORRES (NEW STORE ENROLLMENTS)
(847) 916-4463
Entity
Organization
Contact information
Practice address
6843 MISSION ST, DALY CITY, CA 94014-2006
(650) 992-9490
(650) 992-9504
Mailing address
6843 MISSION ST, DALY CITY, CA 94014-2006
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
PHY43550
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0579194
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
06/01/2006
Last updated
08/22/2020
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