Provider Demographics
NPI:1851551378
Name:K VA T FOOD STORES INC
Entity Type:Organization
Organization Name:K VA T FOOD STORES INC
Other - Org Name:FOOD CITY PHARMACY # 682
Other - Org Type:Other Name
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 1:7608 MOUNTAIN GROVE DRIVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-6755
Practice Address - Country:US
Practice Address - Phone:865-573-5090
Practice Address - Fax:865-577-0079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1506440OtherTENNCARE CROSSOVER
600002658OtherRAILROAD MEDICARE
353148OtherANTHEM BC BS
TN4191319OtherBLUE CROSS BLUE SHIELD OF TN
4441402OtherNCPDP
TN3913901Medicare PIN
4441402OtherNCPDP