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General NPI Number Information
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NPI Number | 1003602483
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Entity Type | Organization
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Legal Business Name | K&R SMOOTHIE BAR, LLC
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Dates
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Enumeration Date | 04/15/2025
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Last Update Date | 04/15/2025
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Provider Practice Location Address
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Address Line | 1900 LEGACY CIR
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City | OPELIKA
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State | AL
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Zip | 36801-5084
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Country | US
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Telephone | 334-473-7710
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Fax |
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Provider Business Mailing Address
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Address Line | 1900 LEGACY CIR
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City | OPELIKA
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State | AL
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Zip | 36801-5084
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Country | US
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Telephone | 334-473-7710
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Fax |
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Authorized Official
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Title or Position | CEO AND FOUNDER
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Name | DR. RONNY SMITH
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Credential |
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Telephone | 334-473-7710
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174200000X
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Taxonomy Name | Meals Provider
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License Number |
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License Number State |
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