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
207 WOODLAND DR SW, WISE, VA 24293-4605
(276) 328-4651
(276) 328-4714
Mailing address
PO BOX 1158, ABINGDON, VA 24212-1158
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
0201003675
VA
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008505349
—
VA
01
—
009102876
VA MEDICAID DME
VA
01
—
228883
ANTHEM BCBS
—
01
—
4046676
BCBS OF TENNESSEE
TN
01
—
4834607
NCPDP
—
01
—
P00364986
RAILROAD MEDICARE
—
Enumeration date
07/15/2006
Last updated
06/26/2014
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