Organization
K VA T FOOD STORES INC
Active
Other names
Food City Pharmacy #680
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
4344 MAYNARDVILLE HWY, MAYNARDVILLE, TN 37807-3618
(865) 992-0534
(865) 577-0079
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
—
1507770
TENNCARE CROSSOVER
TN
01
—
354500
ANTHEM BCBS MEDIGAP
—
01
—
4191321
BLUE CROSS BLUE SHIELD OF TN
TN
01
—
4441539
NCPDP
—
01
—
600002658
RAILROAD MEDICARE
TN
Enumeration date
07/31/2008
Last updated
06/26/2014
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