Organization
K VA T FOOD STORES INC
Active
Organization
K VA T FOOD STORES INC
Active
Other names
FOOD CITY PHARMACY 612
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEVEN C SMITH (CHAIRMAN PRESIDENT CEO)
(276) 623-5100
Entity
Organization
Contact information
Practice address
1287 E MAIN ST, ROGERSVILLE, TN 37857-6922
(423) 272-3790
(423) 272-3940
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
—
1510116
TENNCARE CROSSOVER
TN
01
—
357534
ANTHEM BLUE CROSS BLUE SHIELD MEDIGAP
—
01
—
4198608
BLUE CROSS BLUE SHIELD OF TN
TN
01
—
4441630
NCPDP
—
01
—
600002658
RAILROAD MEDICARE
SD
Enumeration date
08/28/2008
Last updated
03/16/2010
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