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General NPI Number Information
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NPI Number | 1750328415
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Entity Type | Organization
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Legal Business Name | LUCKY STORES II LLC
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Dates
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Enumeration Date | 06/01/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 2175 GRANT RD
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City | LOS ALTOS
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State | CA
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Zip | 94024-6952
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Country | US
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Telephone | 650-969-0772
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Fax | 650-969-1887
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Provider Business Mailing Address
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Address Line | 2175 GRANT RD
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City | LOS ALTOS
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State | CA
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Zip | 94024-6952
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | NEW STORE ENROLLMENTS
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Name | LORENZO TORRES
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Credential |
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Telephone | 847-916-4463
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PHY39208
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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