Healthcare Provider Details

I. General information

NPI: 1932047495
Provider Name (Legal Business Name): CASSIDY JO JANSEN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GOOD SAMARITAN WAY
MOUNT VERNON IL
62864-2402
US

IV. Provider business mailing address

118 RIDGE VIEW DR
DAMIANSVILLE IL
62215-1327
US

V. Phone/Fax

Practice location:
  • Phone: 618-899-3440
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.305560
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: