Organization
K-VA-T FOOD STORES INC
Active
Other names
Food City Pharmacy #428
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN C SMITH (PRESIDENT & CEO)
(276) 623-5100
Entity
Organization
Contact information
Practice address
110 NORTH 11TH STREET, MIDDLESBORO, KY 40965
(606) 248-7689
(606) 242-3079
Mailing address
PO BOX 1158, ABINGDON, VA 24212-1158
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
06758
KY
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
008515981
MEDICAID
VA
01
—
009111387
MEDICAID DME
VA
01
—
1827320
NCPDP
KY
01
—
1827320
OTHER ID NUMBER-COMMERCIAL NUMBER
—
01
—
4033467
BCBS
TN
01
—
435579
ANTHEM BCBS
KY
05
—
54003272
—
KY
01
—
90004813
MEDICAID DME
KY
01
—
FLU0297
MEDICARE FLU
KY
01
—
P00339233
RAILROAD MEDICARE
KY
Enumeration date
07/15/2006
Last updated
04/03/2026
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