Organization
ST LUKES - ST VINCENTS HEALTHCARE
Active
Other names
Ascension Rx 1403
Organization subpart
No
Provider details
NPI number
Authorized official
COBA SUSAN CORNEJO (CHIEF OPERATING OFFICER)
(803) 463-5837
Entity
Organization
Contact information
Practice address
1 SHIRCLIFF WAY, STE 1734, JACKSONVILLE, FL 32204
(904) 308-7515
(904) 308-7514
Mailing address
1 SHIRCLIFF WAY, STE 1734, JACKSONVILLE, FL 32204
(904) 308-7515
(904) 308-7514
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
022451100
—
FL
05
—
22451101
—
FL
Enumeration date
10/03/2006
Last updated
09/02/2025
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