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General NPI Number Information
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NPI Number | 1932029964
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Entity Type | Organization
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Legal Business Name | MIX IT UP BEVERAGE CO LLC
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Dates
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Enumeration Date | 07/20/2026
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Last Update Date | 07/20/2026
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Provider Practice Location Address
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Address Line | 850 NW BROAD ST
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City | MURFREESBORO
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State | TN
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Zip | 37129-2740
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Country | US
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Telephone | 414-512-1922
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Fax |
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Provider Business Mailing Address
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Address Line | 2308 ORWELL ST
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City | MURFREESBORO
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State | TN
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Zip | 37129-3568
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Country | US
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Telephone | 414-578-9717
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. ANIYA GARVIN
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Credential |
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Telephone | 414-578-9717
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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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