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General NPI Number Information
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NPI Number | 1699792051
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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 | 07/15/2006
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Last Update Date | 09/26/2007
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Provider Practice Location Address
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Address Line | 1921 HIGHWAY 394
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City | BLOUNTVILLE
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State | TN
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Zip | 37617-5454
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Country | US
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Telephone | 423-323-3312
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Fax | 423-323-1836
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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 |
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Fax |
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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 | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 3663
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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