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
5560 DICKENSON HIGHWAY BX 789, CLINTWOOD, VA 24228
(276) 926-6002
(276) 926-6031
Mailing address
PO BOX 1158, ABINGDON, VA 24212-1158
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
0201003433
VA
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008517398
—
VA
01
—
009117831
VA MEDICAID DME
VA
01
—
276170
ANTHEM BCBS
—
01
—
3164033
BCBS OF TENNESSEE
TN
01
—
4833162
NCPDP
—
01
—
P00364986
RAILROAD MEDICARE
—
Enumeration date
07/26/2006
Last updated
02/29/2024
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