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
429 UNIVERSITY DR, PRESTONSBURG, KY 41653-1071
(606) 889-9572
(606) 889-6546
Mailing address
PO BOX 1158, ABINGDON, VA 24212-1158
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
07021
KY
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
172537
ANTHEM BCBS
KY
01
—
1828877
NCPDP
KY
01
—
1828877
OTHER ID NUMBER-COMMERCIAL NUMBER
—
01
—
3810003128
WEST VA MEDICAID
WV
01
—
4107719
BCBS TENNESSEE
TN
05
—
54010178
—
KY
01
—
90009747
MEDICAID DME
KY
01
—
FLU0297
MEDICARE FLU SHOT
KY
01
—
P00339233
RAILROAD MEDICARE
KY
Enumeration date
07/15/2006
Last updated
01/24/2019
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