Healthcare Provider Details

I. General information

NPI: 1366856916
Provider Name (Legal Business Name): KELLY TOTH PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY GILMER

II. Dates (important events)

Enumeration Date: 06/11/2014
Last Update Date: 05/17/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3971 BRAMBLETON AVE
ROANOKE VA
24018-6402
US

IV. Provider business mailing address

684 NORTHRIDGE RD
HARDY VA
24101-4255
US

V. Phone/Fax

Practice location:
  • Phone: 540-725-3808
  • Fax:
Mailing address:
  • Phone: 484-336-6914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202219147
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number0202219147
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: