Provider Demographics
NPI:1235802299
Name:K -VA -T FOOD STORES INC
Entity Type:Organization
Organization Name:K -VA -T FOOD STORES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
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 1:16410 WISE STREET (P.O. BOX 306)
Mailing Address - Street 2:
Mailing Address - City:ST. PAUL
Mailing Address - State:VA
Mailing Address - Zip Code:24283
Mailing Address - Country:US
Mailing Address - Phone:276-762-5831
Mailing Address - Fax:
Practice Address - Street 1:16410 WISE STREET BX 306
Practice Address - Street 2:
Practice Address - City:ST. PAUL
Practice Address - State:VA
Practice Address - Zip Code:24283
Practice Address - Country:US
Practice Address - Phone:276-762-5831
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy