Organization
K VA T FOOD STORES INC
Active
Organization
K VA T FOOD STORES INC
Active
Other names
Food City Pharmacy #646
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
4100 COOL SPRINGS ROAD, MORRISTOWN, TN 37814
(423) 317-5020
(423) 318-6999
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
—
1523264
TENNCARE CROSSOVER
TN
01
—
414557
ANTHEM BCBS
TN
01
—
4277861
BC BS TN
TN
01
—
4277861
BLUE CROSS BLUE SHIELD OF TN
—
01
—
4443571
NCPDP
TN
Enumeration date
09/17/2010
Last updated
02/07/2012
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