Organization
K-VA-T FOOD STORES, INC.
Active
Other names
Food City Pharmacy #233
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
112 CRIMSON DRIVE, TRENTON, GA 30752
(706) 657-3734
(706) 657-3734
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
05
—
003168110A
—
GA
01
—
P01659427
RR MEDICARE FLU
GA
Enumeration date
09/15/2015
Last updated
07/12/2016
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