Organization
K-VA-T FOOD STORES, INC.
Active
Other names
FOOD CITY PHARMACY #839
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
18765 RIVERSIDE DRIVE, VANSANT, VA 24656
(276) 935-7455
(276) 935-7713
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
—
00109F
PART B FLU
VA
05
—
1326463878
—
VA
01
—
P00364986
RR FLU
VA
Enumeration date
02/20/2014
Last updated
03/02/2016
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