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Provider Information for 1477806065


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K-VA-T FOOD STORES, INC

Other Names:  
Doing Business As: 
FOOD CITY PHARMACY #743

Organization Subpart: NO

NPI: 1477806065
Last Updated: 2025-01-14
Certification Date: 2025-01-14

Details

NameValue
NPI1477806065
Enumeration Date2012-10-19
NPI TypeNPI-2 Organization
StatusActive
Authorized Official Information Name: STEVEN C SMITH
Title: President & CEO
Phone: 2766235100
Mailing Address PO BOX 1158
ABINGDON, VA 24212-1158
United States

Phone: 276-623-5100 | Fax:276-623-5440
 
Primary Practice Address 2310 MCGRADY DRIVE
CLEVELAND, TN 37323
United States

Phone: 423-599-7053 | Fax:423-790-0006
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Other (non-Medicare)4445397NCPDP Provider Identification Number
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 3336C0003X - Pharmacy - Community/Retail PharmacyTN5095