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Contact Information

LUCKY STORES II LLC
915 MONTGOMERY VILLAGE COURT
SANTA ROSA, CA95405
 Phone: 707-542-1879
 Fax: 707-542-4615
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Community/Retail Pharmacy

3336C0003X 58 Medical Supply Company with Pharmacist
 

Pharmacy

333600000X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for LUCKY STORES II LLC

NPI # 1922046184
LBN Legal business name LUCKY STORES II LLC
Authorized official LORENZO TORRES - (NEW STORE ENROLLMENTS)
Entity Organization
Organization subpart 1 No
Enumeration date 06/02/2006
Last updated 09/11/2025 - About 9 months ago
Identifiers
CA License # PHY46285
Other 0588624 OTHER ID NUMBER-COMMERCIAL NUMBER
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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