Provider Demographics
NPI:1326328139
Name:JANSEN, JOANNE R (PHARMD, BCACP)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:R
Last Name:JANSEN
Suffix:
Gender:F
Credentials:PHARMD, BCACP
Other - Prefix:
Other - First Name:JOANNE
Other - Middle Name:R
Other - Last Name:LOGSDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD, BCACP
Mailing Address - Street 1:289 IRELAND AVE
Mailing Address - Street 2:BLDG 851, ROOM NBG-30
Mailing Address - City:FORT KNOX
Mailing Address - State:KY
Mailing Address - Zip Code:40121-5111
Mailing Address - Country:US
Mailing Address - Phone:502-624-9478
Mailing Address - Fax:502-624-0261
Practice Address - Street 1:200 BRULE STREET
Practice Address - Street 2:ATTN: PHARMACY
Practice Address - City:FORT KNOX
Practice Address - State:KY
Practice Address - Zip Code:40121
Practice Address - Country:US
Practice Address - Phone:502-626-9865
Practice Address - Fax:502-624-0333
Is Sole Proprietor?:No
Enumeration Date:2011-08-24
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY015066183500000X, 1835P0018X, 1835P2201X
IN26023873A1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
No183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist