Organization
K VA T FOOD STORES INC
Active
Other names
FOOD CITY PHARMACY #661
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEVEN C SMITH (CHAIRMAN PRESIDENT CEO)
(276) 623-5100
Entity
Organization
Contact information
Practice address
2221 JACKSBORO PIKE, SUITE B1, LAFOLLETTE, TN 37766-3006
(423) 566-2033
(423) 566-9510
Mailing address
PO BOX 1158, ABINGDON, VA 24212-1158
(276) 623-5100
(276) 623-5440
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1521129
TENNCARE CROSSOVER
TN
01
—
404207
ANTHEM BCBS
—
01
—
4266131
BCBS TN
TN
01
—
4443103
NCPDP
TN
Enumeration date
03/18/2010
Last updated
02/07/2012
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