NPIMap

Organization Active NPI

Lucky Stores II LLC

  • Community/Retail Pharmacy
  • Tracy, CA
National Provider Identifier
1104863620
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
LUCKY STORES II LLC
Practice address
875 S Tracy Blvd
Tracy, CA 95376-4744
Phone
(209) 830-1977
Fax
(209) 830-1987
NPI assigned
Jun 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Lorenzo Torres
Title
New Store Enrollments
Phone
(847) 916-4463

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X PHY42087 CA
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

875 S Tracy Blvd
Tracy, CA 95376-4744

Mailing address

875 S Tracy Blvd
Tracy, CA 95376-4744

Other identifiers 1

IdentifierTypeStateIssuer
0568797OtherOTHER ID NUMBER-COMMERCIAL NUMBER

Other names 1

  • SAVON DRUGS Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Lucky Stores II LLC60 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 20

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 20

Locations

875 S Tracy Blvd
Tracy, CA 95376
Phone (209) 830-1977

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1104863620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "875 S TRACY BLVD",
            "city": "TRACY",
            "state": "CA",
            "postal_code": "953764744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "875 S TRACY BLVD",
            "city": "TRACY",
            "state": "CA",
            "postal_code": "953764744",
            "telephone_number": "209-830-1977",
            "fax_number": "209-830-1987"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUCKY STORES II LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-01",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "TORRES",
        "authorized_official_first_name": "LORENZO",
        "authorized_official_title_or_position": "NEW STORE ENROLLMENTS",
        "authorized_official_telephone_number": "847-916-4463"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "CA",
            "license": "PHY42087",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "0568797",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SAVON DRUGS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tracy, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.