Provider Demographics
NPI:1942817911
Name:VIVENT PHARMACY LLC
Entity Type:Organization
Organization Name:VIVENT PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF PHARMACY OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-223-6874
Mailing Address - Street 1:648 N PLANKINTON AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53203-2928
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:833-368-1247
Practice Address - Street 1:104 E HIGHLAND MALL BLVD STE 100A
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-3776
Practice Address - Country:US
Practice Address - Phone:833-366-6664
Practice Address - Fax:877-770-9910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-24
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy