Provider Demographics
NPI:1700034022
Name:K VA T FOOD STORES INC
Entity Type:Organization
Organization Name:K VA T FOOD STORES INC
Other - Org Name:FOOD CITY PHARMACY 612
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 1:1287 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ROGERSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37857-6922
Practice Address - Country:US
Practice Address - Phone:423-272-3790
Practice Address - Fax:423-272-3940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-28
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1510116OtherTENNCARE CROSSOVER
4441630OtherNCPDP
357534OtherANTHEM BLUE CROSS BLUE SHIELD MEDIGAP
TN4198608OtherBLUE CROSS BLUE SHIELD OF TN
SD600002658OtherRAILROAD MEDICARE
SD600002658OtherRAILROAD MEDICARE
357534OtherANTHEM BLUE CROSS BLUE SHIELD MEDIGAP