Organization
K -VA -T FOOD STORES INC
Active
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
2120 S ROAN ST, JOHNSON CITY, TN 37601-7675
(423) 979-0373
(423) 979-0372
Mailing address
PO BOX 1158, ABINGDON, VA 24212-1158
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
3887
TN
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008520330
—
VA
01
—
009999426
MEDICAID DME VA
VA
01
—
1454311
TENNCARE DME CROSSOVER
TN
01
—
278425
ANTHEM BCBS
—
01
—
3913901
MEDICARE FLU SHOTS
—
01
—
4059488
BCBS TENNESSEE
TN
01
—
4436451
NCPDP
—
01
—
600002658
RAILROAD MEDICARE
—
Enumeration date
07/15/2006
Last updated
03/06/2024
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