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
1000 LADD LANDING BLVD, KINGSTON, TN 37763-2366
(865) 717-7085
(865) 717-7146
Mailing address
PO BOX 1158, ABINGDON, VA 24212-1158
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
3791
TN
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010365902
MEDICAID DME
VA
05
—
010365911
—
VA
01
—
1454320
TENNCARE DME
TN
01
—
275658
ANTHEM BCBS
—
05
—
3810005490
—
WV
01
—
3913901
MEDICARE FLU SHOTS
—
01
—
4036716
BCBS OF TENNESSEE
TN
01
—
4435788
NCPDP
—
01
—
600002658
RAILROAD MEDICARE
—
Enumeration date
07/15/2006
Last updated
07/13/2012
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