Provider Demographics
NPI:1326463878
Name:K-VA-T FOOD STORES, INC.
Entity Type:Organization
Organization Name:K-VA-T FOOD STORES, INC.
Other - Org Name:FOOD CITY PHARMACY #839
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN, 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: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:276-623-5100
Mailing Address - Fax:276-623-5440
Practice Address - Street 1:18765 RIVERSIDE DRIVE
Practice Address - Street 2:
Practice Address - City:VANSANT
Practice Address - State:VA
Practice Address - Zip Code:24656
Practice Address - Country:US
Practice Address - Phone:276-935-7455
Practice Address - Fax:276-935-7713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-20
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00109FOtherPART B FLU
VA1326463878Medicaid
VAP00364986OtherRR FLU
VA1326463878Medicaid