Provider Demographics
NPI:1639353733
Name:K VA T FOOD STORES INC
Entity Type:Organization
Organization Name:K VA T FOOD STORES INC
Other - Org Name:FOOD CITY PHARMACY #609
Other - Org Type:Other Name
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: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 1:2946 WINFIELD DUNN PARKWAY
Practice Address - Street 2:
Practice Address - City:KODAK
Practice Address - State:TN
Practice Address - Zip Code:37764-4309
Practice Address - Country:US
Practice Address - Phone:865-933-4676
Practice Address - Fax:865-933-4501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1455265OtherTN CROSSOVER
344784OtherANTHEM BCBS MEDIGAP
4440955OtherNCPDP
600002658OtherRAILROAD MEDICARE
TN4171342OtherBC BS OF TN
TN1455265OtherTN CROSSOVER
4440955OtherNCPDP