Provider Demographics
NPI:1629227061
Name:LOEBEL, KAREN M (PHARMD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:M
Last Name:LOEBEL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 ROYAL DR
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53090-5424
Mailing Address - Country:US
Mailing Address - Phone:765-532-9570
Mailing Address - Fax:
Practice Address - Street 1:1629 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-4935
Practice Address - Country:US
Practice Address - Phone:262-335-2292
Practice Address - Fax:262-335-4199
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2020-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN119506183500000X
WI14794-4041835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI14794-040OtherWI PHARMACIST LISCENSE