# VIVENT PHARMACY ILLINOIS LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003509019
- **Authorized official:** TONY FIELDS (CHIEF PHARMACY OFFICER)
- **Authorized official phone:** (414) 223-6874

## Contact information

- **Practice address:** 5537 N BROADWAY ST STE 101, CHICAGO, IL 60640-1405
- **Practice address phone:** (888) 655-2078
- **Practice address fax:** (872) 813-4226
- **Mailing address:** 1311 N 6TH ST STE 201, MILWAUKEE, WI 53212-4006
- **Mailing address phone:** (800) 359-9272
- **Mailing address fax:** (833) 368-1247

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 05/26/2023
- **Last updated:** 04/08/2024