Organization
VIVENT PHARMACY LLC
Active
Other names
Vivent Pharmacy, AMC Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
TONY FIELDS PHARMD (CHIEF PHARMACY OFFICER)
(414) 223-6874
Entity
Organization
Contact information
Practice address
1311 N 6TH ST STE 101, MILWAUKEE, WI 53212-4006
(888) 393-0351
(833) 368-1247
Mailing address
1311 N 6TH ST STE 201, MILWAUKEE, WI 53212-4006
(833) 368-1247
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
—
—
3336C0003X
Community/Retail Pharmacy
9049-42
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100013165
—
WI
01
—
2128078
PK
—
Enumeration date
11/18/2010
Last updated
05/02/2024
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