Provider Demographics
NPI:1114944691
Name:K VA T FOOD STORES INC
Entity Type:Organization
Organization Name:K VA T FOOD STORES INC
Other - Org Name:FOOD CITY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-623-5100
Mailing Address - Street 1:PO BOX 1158
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24212-1158
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1235 BONHAM RD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24202-6011
Practice Address - Country:US
Practice Address - Phone:276-669-2388
Practice Address - Fax:276-669-2721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0003X
VA0201003682333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3149004OtherBCBS OF TENNESSEE
4834657OtherOTHER ID NUMBER-COMMERCIAL NUMBER
VA008505187Medicaid
VA009102787OtherVA MEDICAID DME
P00364986OtherRAILROAD MEDICARE
102489OtherANTHEM BCBS
4834657OtherNCPDP
TN3149004OtherBCBS OF TENNESSEE
VA008505187Medicaid