Organization
LUCKY STORES II LLC
Active
Other names
SAVON PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
LORENZO TORRES (NEW STORE ENROLLMENTS)
(847) 916-4463
Entity
Organization
Contact information
Practice address
2980 E CAPITOL EXPY, SAN JOSE, CA 95148-4246
(408) 274-5939
(408) 274-5954
Mailing address
2980 E CAPITOL EXPY, SAN JOSE, CA 95148-4246
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
PHY45602
CA
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0564941
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
06/01/2006
Last updated
09/11/2025
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