Healthcare Provider Details

I. General information

NPI: 1144950056
Provider Name (Legal Business Name): VIVENT PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2022
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 N 6TH ST STE 102
MILWAUKEE WI
53212-4006
US

IV. Provider business mailing address

1311 N 6TH ST STE 201
MILWAUKEE WI
53212-4006
US

V. Phone/Fax

Practice location:
  • Phone: 414-223-6820
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TONY FIELDS
Title or Position: CHIEF PHARMACY OFFICER
Credential:
Phone: 414-223-6874