1629227061 NPI number — KAREN M LOEBEL PHARM.D.

Table of content: KAREN M LOEBEL PHARM.D. (NPI 1629227061)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629227061 NPI number — KAREN M LOEBEL PHARM.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOEBEL
Provider First Name:
KAREN
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARM.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629227061
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/25/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
825 ROYAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST BEND
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53090-5424
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-532-9570
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1629 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST BEND
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53095-4935
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-335-2292
Provider Business Practice Location Address Fax Number:
262-335-4199
Provider Enumeration Date:
09/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  119506 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1835P0018X , with the licence number: 14794-404 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 14794-040 . This is a "WI PHARMACIST LISCENSE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




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