| Organization Name: | LUCKY STORES II LLC |
| NPI Number: | 1013954445 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LORENZO TORRES (NEW STORE ENROLLMENTS) |
| Mailing Address: | 7707 Laguna Blvd Elk Grove |
| State: | CA US |
| Postal Code: | 957585062 |
| Phone Number: | 9166835120 |
| Fax Number: | 9166835133 |
| NPI Enumeration Date: | 06/02/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 333600000X |
| License Number: | PHY42027 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | CA |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Pharmacy |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located. |