Organization
K VA T FOOD STORES INC
Active
Other names
Food City Pharmacy #617
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN C SMITH (PRESIDENT & CEO)
(276) 623-5100
Entity
Organization
Contact information
Practice address
1430 VOLUNTEER PARKWAY, BRISTOL, TN 37620
(423) 968-2222
(423) 968-2248
Mailing address
PO BOX 1158, ABINGDON, VA 24212-1158
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
3644
TN
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008503940
—
TN
01
—
009102116
MEDICAID DME
TN
01
—
103115
ANTHEM BCBS
—
01
—
1454302
TENNCARE
TN
01
—
3157249
BCBS OF TENNESSEE
TN
01
—
3913901
MEDICARE FLU SHOTS
—
01
—
4434673
NCPDP
—
01
—
600002658
RAILROAD MEDICARE
—
Enumeration date
07/17/2006
Last updated
08/24/2018
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