Organization
K -VA -T FOOD STORES INC
Active
Other names
Food City Pharmacy #645
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
1410 N BROAD ST, TAZEWELL, TN 37879-4350
(423) 626-2344
(423) 626-2877
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
05
—
1527823
—
TN
01
—
417976
ANTHEM BC BS
—
01
—
4282885
BC BS TN
TN
01
—
4443874
NCPDP
TN
Enumeration date
12/15/2010
Last updated
12/21/2018
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