MEDICARE: KAREN M LOEBEL PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	119506	MN
2	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	14794-404	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14794-040	OTHER	WI	WI PHARMACIST LISCENSE

General Provider Information

NPI Number	:	1629227061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN M LOEBEL PHARM.D.

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

Provider Business Practice Location Address
First Line	:	1629 S MAIN ST
Second Line	:
City	:	WEST BEND
State	:	WI
Zip	:	53095-4935
Country	:	US
Telephone Number	:	262-335-2292
Fax Number	:	262-335-4199

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/10/2008
Last Update Date	:	01/25/2020

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