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
1921 HIGHWAY 394, BLOUNTVILLE, TN 37617-5454
(423) 323-3312
(423) 323-1836
Mailing address
PO BOX 1158, ABINGDON, VA 24212-1158
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
3663
TN
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1454312
TENNCARE DME
TN
01
—
229815
ANTHEM BCBS
—
01
—
3913901
MEDICARE FLU SHOTS
—
01
—
4000730
BCBS OF TENNESSEE
TN
01
—
4435029
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
07/15/2006
Last updated
09/26/2007
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