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
500 FOREST DR, JONESBOROUGH, TN 37659-1510
(423) 753-3468
(423) 753-4274
Mailing address
PO BOX 1158, ABINGDON, VA 24212-1158
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
3995
TN
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
113916
ANTHEM BCBS
—
01
—
1454477
TENNCARE DME
TN
01
—
3913901
MEDICARE FLU SHOTS
—
01
—
4081105
BCBS OF TENNESSEE
TN
01
—
4437237
NCPDP
—
01
—
600002658
RAILROAD MEDICARE
—
Enumeration date
07/15/2006
Last updated
01/24/2019
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