Healthcare Provider Details

I. General information

NPI: 1013838374
Provider Name (Legal Business Name): VICTORIA GRUSAUSKAS
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PALM AVE
JACKSONVILLE FL
32207-8432
US

IV. Provider business mailing address

2137 BLUE HERON COVE DR
FLEMING ISLAND FL
32003-4929
US

V. Phone/Fax

Practice location:
  • Phone: 904-202-7300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License NumberPS64379
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: