Organization
K VA T FOOD STORES INC
Active
Other names
Food City Pharmacy #609
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEVEN C SMITH (PRESIDENT & CEO)
(276) 623-5100
Entity
Organization
Contact information
Practice address
2946 WINFIELD DUNN PARKWAY, KODAK, TN 37764-4309
(865) 933-4676
(865) 933-4501
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
—
1455265
TN CROSSOVER
TN
01
—
344784
ANTHEM BCBS MEDIGAP
—
01
—
4171342
BC BS OF TN
TN
01
—
4440955
NCPDP
—
01
—
600002658
RAILROAD MEDICARE
—
Enumeration date
12/26/2007
Last updated
06/26/2014
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