Organization
K -VA -T FOOD STORES INC
Active
Other names
Food City Pharmacy #663
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN C SMITH (CHAIRMAN, PRESIDENT & CEO)
(276) 623-5100
Entity
Organization
Contact information
Practice address
2755 E ANDREW JOHNSON HWY, GREENEVILLE, TN 37745-0955
(423) 525-4221
(423) 525-4783
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
—
1533896
MEDICAID DME
TN
01
—
484704
ANTHEM BCBS
VA
Enumeration date
01/16/2013
Last updated
06/11/2020
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