Provider Demographics
NPI:1306863766
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 1:207 WOODLAND DR SW
Practice Address - Street 2:
Practice Address - City:WISE
Practice Address - State:VA
Practice Address - Zip Code:24293-4605
Practice Address - Country:US
Practice Address - Phone:276-328-4651
Practice Address - Fax:276-328-4714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0003X
VA0201003675333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4834607OtherNCPDP
VA008505349Medicaid
228883OtherANTHEM BCBS
P00364986OtherRAILROAD MEDICARE
VA009102876OtherVA MEDICAID DME
TN4046676OtherBCBS OF TENNESSEE
4834607OtherOTHER ID NUMBER-COMMERCIAL NUMBER
TN4046676OtherBCBS OF TENNESSEE
VA008505349Medicaid