Provider Demographics
NPI:1033552708
Name:SHIELDS, TONI L (RPH)
Entity Type:Individual
Prefix:MRS
First Name:TONI
Middle Name:L
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 SLOAN AVE.
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:MO
Mailing Address - Zip Code:64080
Mailing Address - Country:US
Mailing Address - Phone:913-378-6938
Mailing Address - Fax:
Practice Address - Street 1:1411 SLOAN AVE.
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:MO
Practice Address - Zip Code:64080
Practice Address - Country:US
Practice Address - Phone:913-378-6938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-12
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-11239183500000X, 1835N1003X
MO044664183500000X, 1835N1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835N1003XPharmacy Service ProvidersPharmacistNutrition Support