K-VA-T Food Stores, Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

5095 Issued in TN

Legal business name

K-VA-T FOOD STORES, INC

Doing business as

Food City Pharmacy #743

Practice address

2310 McGrady Drive
Cleveland, TN 37323

Phone

(423) 599-7053

Fax

(423) 790-0006

NPI assigned

Oct 19, 2012

Last updated

Jan 14, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Steven C Smith

Title

President & Ceo

Phone

(276) 623-5100

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Food City Pharmacy #743 Doing business as

Medicare fee-for-service enrollment

Enrolled in TN3 enrollments

Enrollment records 3

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• K-VA-T Food Stores Inc

  dba Food City Pharmacy #745

  • Community/Retail Pharmacy
  • Ocoee, TN
  • NPI 1114310224

  O20160415000632

  Same enrollment

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Tax ID family

Cooke Food Store Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Cooke Food Store Inc

  dba Cooke's Pharmacy

  • Long Term Care Pharmacy
  • Cleveland, TN
  • NPI 1972153708
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1350604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736812800000",
    "number": "1477806065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1158",
            "city": "ABINGDON",
            "state": "VA",
            "postal_code": "242121158",
            "telephone_number": "276-623-5100",
            "fax_number": "276-623-5440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2310 MCGRADY DRIVE",
            "city": "CLEVELAND",
            "state": "TN",
            "postal_code": "37323",
            "telephone_number": "423-599-7053",
            "fax_number": "423-790-0006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "K-VA-T FOOD STORES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-19",
        "last_updated": "2025-01-14",
        "certification_date": "2025-01-14",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "276-623-5100"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TN",
            "license": "5095",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "4445397",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Food City Pharmacy #743",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mark Daniel Juriga, DPT
• Megan Randolph Justice, RSA
• Laura H Justiss, MFTA
• K VA T Food Stores Inc (Food City Pharmacy #739)
• K VA T Food Stores, Inc. (Food City Pharmacy #712)
• Emily Kabilus, RN
• Kaful Double Portion Family Practice, Inc
• Kah Development 8, LLC (Gentiva I)
• Samantha Macchio Kapperman, OD
• Karin Moore

• Community/Retail Pharmacy in Cleveland, TN
• Providers in Cleveland, TN by specialty
• Community/Retail Pharmacy in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.