Organization
VIVENT PHARMACY ILLINOIS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TONY FIELDS (CHIEF PHARMACY OFFICER)
(414) 223-6874
Entity
Organization
Contact information
Practice address
5537 N BROADWAY ST STE 101, CHICAGO, IL 60640-1405
(888) 655-2078
(872) 813-4226
Mailing address
1311 N 6TH ST STE 201, MILWAUKEE, WI 53212-4006
(800) 359-9272
(833) 368-1247
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Enumeration date
05/26/2023
Last updated
04/08/2024
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