LUCKY STORES II LLC (NPI# 1215974647) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215974647 |
| Entity Type | Organization |
| Organization Name | LUCKY STORES II LLC |
| Other Organization Name | SAVON PHARMACY |
| Practice Address |
5060 Foothills Blvd Roseville CA 95747-6500 |
| Practice Telephone | 9167822720 |
| Practice Fax Number | 9167827273 |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | LORENZO TORRES (NEW STORE ENROLLMENTS) |
| Authorized Official Telephone | 8479164463 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 333600000X | Pharmacy | PHY41080 | CA | Suppliers |
| X | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OTHER ID NUMBER-COMMERCIAL NUMBER | 0523515 | 01 |
| Other Name | Type Code |
|---|---|
| SAVON PHARMACY | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922047307 | Lucky Stores II LLC | Pharmacy | 2355 California Blvd, Napa, CA 94559-1062 | 2006-06-04 |
| 1770520108 | Lucky Stores II LLC | Pharmacy | 1465 Main St, Watsonville, CA 95076-3759 | 2006-06-02 |
| 1932146362 | Lucky Stores II LLC | Pharmacy | 700 Gray Ave, Yuba City, CA 95991-3621 | 2006-06-02 |
| 1689611014 | Lucky Stores II LLC | Pharmacy | 129 Bernal Rd, San Jose, CA 95119-1303 | 2006-06-02 |
| 1295772622 | Lucky Stores II LLC | Pharmacy | 291 Mccray St, Hollister, CA 95023-4094 | 2006-06-02 |
| 1760420780 | Lucky Stores II LLC | Pharmacy | 3100 E 9th St, Oakland, CA 94601 | 2006-06-02 |
| 1306883731 | Lucky Stores II LLC | Pharmacy | 1951 Holmes St, Livermore, CA 94550-6015 | 2006-06-02 |
| 1124065552 | Lucky Stores II LLC | Pharmacy | 4220 Florin Rd, Sacramento, CA 95823-2508 | 2006-06-02 |
| 1861439291 | Lucky Stores II LLC | Pharmacy | 5000 Mowry Ave, Fremont, CA 94538-1045 | 2006-06-02 |
| 1760429195 | Lucky Stores II LLC | Pharmacy | 1312 Trancas St, Napa, CA 94558-2912 | 2006-06-02 |
| Street Address |
5060 FOOTHILLS BLVD |
| City | ROSEVILLE |
| State | CA |
| Zip Code | 95747-6500 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326607268 | Jessica Mah | Pharmacist | 5060 Foothills Blvd, Roseville, CA 95747-6500 | 2019-06-12 |
| 1366696841 | Erin Kathleen Tessendorff | Pharmacist | 5060 Foothills Blvd, Roseville, CA 95747-6500 | 2008-11-10 |
| 1144364225 | Save Mart Supermarkets | Pharmacy | 5060 Foothills Blvd, Roseville, CA 95747-6500 | 2007-02-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215407051 | Clifford Leo Faubert | Nurse Practitioner | 1937 Ellesmere Loop, Roseville, CA 95747 | 2018-12-04 |
| 1821577172 | Adam Botwinik | Psychologist | 8849 Cook Riolo Road, Roseville, CA 95747 | 2018-08-08 |
| 1093231201 | Heather Mairi Ybarra | Behavior Technician | 4216 Wyman Way, Roseville, CA 95747 | 2017-08-18 |
| 1881114650 | Bridget Bell | Behavior Technician | 8202 Tail Race Dr, Roseville, CA 95747 | 2017-06-22 |
| 1760911192 | Laura Marie Hummel | Massage Therapist | 9077 Foothills Blvd. Suite 200, Roseville, CA 95747 | 2017-06-08 |
| 1184975625 | Whitney Anne Wright | Marriage & Family Therapist | 7517 Locomotive Ln, Roseville, CA 95747 | 2012-09-24 |
| 1962764290 | Panumas Soukaroon | Physical Medicine & Rehabilitation | Glenwood Springs Way, Roseville, CA 95747 | 2012-06-12 |
| 1134487366 | Tatyana Serikov | Dental Hygienist | 616 Treviso Ct, Roseville, CA 95747 | 2012-04-25 |
| 1720352099 | Peggy Holcomb | Clinical Neuropsychologist | 4010 Foothills Bvld., Ste. 103-3, Roseville, CA 95747 | 2012-03-02 |
| 1740577220 | Laina Marie Haider | Occupational Therapist | 7950 Footthills Blvd, The Bridges At Woodcreek Oaks, Roseville, CA 95747 | 2011-07-05 |
| Find all providers in zip 95747 | ||||
| Taxonomy Code | 333600000X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| 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. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: added definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588217236 | Kaiser Foundation Health Plan Inc | Pharmacy | 1021 Riverside Ave, Roseville, CA 95678 | 2019-07-22 |
| 1568735991 | Kaiser Foundation Health Plan Inc | Pharmacy | 1600 Eureka Rd Bldg 1, Roseville, CA 95661-3027 | 2012-02-15 |
| 1164659355 | Kaiser Foundation Health Plan Inc | Pharmacy | 1600 Eureka Rd Bldg 2, Roseville, CA 95661-3027 | 2009-06-16 |
| 1225103807 | Priceless Drug Store | Pharmacy | 446 Roseville Sq, Roseville, CA 95678-2808 | 2006-11-21 |
| 1992815591 | Costco Wholesale Corporation | Pharmacy | 6750 Stanford Ranch Rd, Roseville, CA 95678 | 2006-08-30 |
| 1720003387 | Bormans Inc | Pharmacy | 30851 Gratiot Ave, Roseville, MI 48066-1769 | 2006-07-13 |
| 1750312740 | Kmart of Michigan Inc | Pharmacy | 17580 Frazho Rd, Roseville, MI 48066-3829 | 2006-07-06 |
| 1417990284 | Longs Drug Stores California Inc | Pharmacy | 900 Sunrise Ave, Roseville, CA 95661-4507 | 2006-06-13 |
| 1295341162 | Central Rx LLC | Pharmacy | 20733 E 13 Mile Rd, Roseville, MI 48066-4503 | 2020-09-16 |
| 1508489303 | Fortify Market | Pharmacy | 1 Adventist Health Way, Roseville, CA 95661-3266 | 2020-05-27 |
| Find all providers in ROSEVILLE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.