Healthcare Provider Details

I. General information

NPI: 1235802299
Provider Name (Legal Business Name): K-VA-T FOOD STORES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2021
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16410 WISE STREET BX 306
ST. PAUL VA
24283
US

IV. Provider business mailing address

PO BOX 306
SAINT PAUL VA
24283-0306
US

V. Phone/Fax

Practice location:
  • Phone: 276-762-5831
  • Fax:
Mailing address:
  • Phone: 276-762-5831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. STEVEN C SMITH
Title or Position: PRESIDENT & CEO
Credential:
Phone: 276-623-5100