Organization
K-VA-T FOOD STORES INC
Active
Other names
Food City Pharmacy #657
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
300 CLINCHFIELD STREET, KINGSPORT, TN 37660-3604
(423) 246-0047
(423) 246-0056
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
4858
TN
3336C0003X
Community/Retail Pharmacy
Primary
4858
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1447549241
VA MEDICAID
VA
05
—
1527770
—
TN
01
—
424094
ANTHEM BCBS
—
01
—
4294262
BC BS TN
TN
01
—
4444294
NCPDP
—
Enumeration date
04/01/2011
Last updated
12/21/2018
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