Provider Demographics
NPI:1831505171
Name:TOLER, KEALY
Entity type:Individual
Prefix:
First Name:KEALY
Middle Name:
Last Name:TOLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1731 HARPER RD
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-3311
Mailing Address - Country:US
Mailing Address - Phone:304-255-1251
Mailing Address - Fax:304-255-2661
Practice Address - Street 1:1731 HARPER RD
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3311
Practice Address - Country:US
Practice Address - Phone:304-255-1251
Practice Address - Fax:304-255-2661
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-08
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP008600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist