Provider Demographics
NPI:1710415138
Name:BALTRUSAITIS, SHANNON LOIS (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:LOIS
Last Name:BALTRUSAITIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:SHANNON
Other - Middle Name:LOIS
Other - Last Name:KLINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:978 N 640TH RD
Mailing Address - Street 2:
Mailing Address - City:BALDWIN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66006-7388
Mailing Address - Country:US
Mailing Address - Phone:913-709-6717
Mailing Address - Fax:
Practice Address - Street 1:2200 SW GAGE BLVD
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66622
Practice Address - Country:US
Practice Address - Phone:785-350-3111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-30
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-1027841835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist