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General NPI Number Information
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NPI Number | 1477806065
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Entity Type | Organization
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Legal Business Name | K-VA-T FOOD STORES, INC
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Dates
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Enumeration Date | 10/19/2012
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 2310 MCGRADY DRIVE
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City | CLEVELAND
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State | TN
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Zip | 37323
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Country | US
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Telephone | 423-599-7053
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Fax | 423-790-0006
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Provider Business Mailing Address
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Address Line | PO BOX 1158
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City | ABINGDON
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State | VA
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Zip | 24212-1158
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Country | US
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Telephone | 276-623-5100
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Fax | 276-623-5440
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | STEVEN C SMITH
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Credential |
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Telephone | 276-623-5100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5095
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License Number State | TN
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