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General NPI Number Information
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NPI Number | 1730994864
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Entity Type | Organization
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Legal Business Name | VIVENT PHARMACY MICHIGAN LLC
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Dates
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Enumeration Date | 02/07/2025
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Last Update Date | 11/10/2025
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Provider Practice Location Address
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Address Line | 64 VICTOR ST STE 101
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City | HIGHLAND PARK
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State | MI
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Zip | 48203-3128
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Country | US
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Telephone | 888-810-1434
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Fax | 313-447-2239
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Provider Business Mailing Address
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Address Line | 1311 N 6TH ST STE 201
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City | MILWAUKEE
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State | WI
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Zip | 53212-4006
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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 | CHIEF PHARMACY OFFICER
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Name | TONY FIELDS
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Credential |
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Telephone | 414-223-6874
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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 |
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License Number State |
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Taxonomy #2
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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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