Organization
K-VA-T FOOD STORES, INC.
Active
Other names
Food City Pharmacy #654
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
507 SOUTH CHARLES SEVIER BOULEVARD, CLINTON, TN 37716
(865) 457-5259
(865) 457-6340
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
—
1510120
TENNCARE CROSSOVER
TN
01
—
359096
ANTHEM BCBS MEDIGAP
—
01
—
4202068
BLUE CROSS BLUE SHIELD OF TN
TN
01
—
4441820
NCPDP
—
01
—
600002658
RAILROAD MEDICARE
TN
Enumeration date
10/16/2008
Last updated
02/01/2010
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