Provider Demographics
NPI:1366856916
Name:TOTH, KELLY (PHARM D)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:TOTH
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:GILMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:684 NORTHRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HARDY
Mailing Address - State:VA
Mailing Address - Zip Code:24101-4255
Mailing Address - Country:US
Mailing Address - Phone:484-336-6914
Mailing Address - Fax:
Practice Address - Street 1:401 S MAIN ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-2955
Practice Address - Country:US
Practice Address - Phone:434-793-2221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP447797183500000X
VA0202219147183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist