Provider Information for 1477806065
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K-VA-T FOOD STORES, INC
Other Names:Doing Business As:FOOD CITY PHARMACY #743Organization Subpart: NO
NPI: 1477806065
Last Updated: 2025-01-14
Certification Date: 2025-01-14
Certification Date: 2025-01-14
Details
Name | Value | ||||||||
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NPI | 1477806065 | ||||||||
Enumeration Date | 2012-10-19 | ||||||||
NPI Type | NPI-2 Organization | ||||||||
Status | Active | ||||||||
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 | ||||||||
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