Organization
K VA T FOOD STORES INC
Active
Other names
Food City Pharmacy #827
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEVEN C SMITH (PRESIDENT & CEO)
(276) 623-5100
Entity
Organization
Contact information
Practice address
1135 CLAYPOOL HILL MALL RD, CEDAR BLUFF, VA 24609-7013
(276) 964-5748
(276) 963-9325
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
—
010314399
VA MEDICAID DME
VA
05
—
010314402
—
VA
01
—
206330
ANTHEM BCBS
—
01
—
4142950
BCBS OF TENNESSEE
TN
01
—
4839378
NCPDP
—
05
—
54012562
—
KY
01
—
7100177680
KY MEDICAID
KY
01
—
90013764
KY MEDICAID DME
KY
01
—
P00364986
RAILROAD MEDICARE
—
Enumeration date
08/16/2006
Last updated
02/07/2012
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