Provider Demographics
NPI:1487948139
Name:IBACH, KAREN I (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:I
Last Name:IBACH
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:PO BOX 390702
Mailing Address - Street 2:
Mailing Address - City:KEAUHOU
Mailing Address - State:HI
Mailing Address - Zip Code:96739-0702
Mailing Address - Country:US
Mailing Address - Phone:541-729-5922
Mailing Address - Fax:
Practice Address - Street 1:74-5455 MAKALA BLVD
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-2727
Practice Address - Country:US
Practice Address - Phone:808-334-4021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-29
Last Update Date:2011-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3056183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist