Organization
K VA T FOOD STORES INC
Active
Other names
FOOD CITY PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN C SMITH (PRESIDENT & CEO)
(276) 623-5100
Entity
Organization
Contact information
Practice address
2135 E BROADWAY AVE, MARYVILLE, TN 37804-3034
(865) 981-4338
(865) 981-4347
Mailing address
PO BOX 1158, ABINGDON, VA 24212-1158
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
1688
TN
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1455076
TENNCARE DME
TN
01
—
191694
ANTHEM BCBS
—
01
—
3913901
MEDICARE FLU SHOTS
—
01
—
4121927
BCBS OF TENNESSEE
TN
01
—
4439178
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
07/15/2006
Last updated
09/25/2007
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