Organization
K-VA-T FOOD STORES, INC.
Active
Other names
Food City Pharmacy #699
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
6681 BRISTOL HIGHWAY, SUITE 300, PINEY FLATS, TN 37686-5206
(423) 538-0253
(423) 538-0358
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
—
1184879488
VA MEDICAID
—
05
—
1516905
—
TN
01
—
361700
ANTHEM BC BS
—
01
—
4208798
BC BS TN
TN
01
—
4441969
NCPDP
—
Enumeration date
12/01/2008
Last updated
06/26/2014
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