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General NPI Number Information
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NPI Number | 1790879732
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Entity Type | Organization
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Legal Business Name | ST LUKES - ST VINCENTS HEALTHCARE
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 1 SHIRCLIFF WAY STE 1734
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City | JACKSONVILLE
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State | FL
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Zip | 32204
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Country | US
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Telephone | 904-308-7515
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Fax | 904-308-7514
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Provider Business Mailing Address
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Address Line | 1 SHIRCLIFF WAY STE 1734
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City | JACKSONVILLE
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State | FL
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Zip | 32204
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Country | US
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Telephone | 904-308-7515
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Fax | 904-308-7514
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | COBA SUSAN CORNEJO
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Credential |
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Telephone | 803-463-5837
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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