1033780937 NPI number — AMC PHARMACY LLC

Table of content: (NPI 1033780937)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033780937 NPI number — AMC PHARMACY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMC PHARMACY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
VIVENT PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033780937
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1311 N 6TH ST STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53212-4006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-359-9272
Provider Business Mailing Address Fax Number:
833-368-1247

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4309 E 50TH TER STE 200A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64130-2853
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-454-8029
Provider Business Practice Location Address Fax Number:
833-753-1098
Provider Enumeration Date:
07/02/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FIELDS
Authorized Official First Name:
TONY
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF PHARMACY OFFICER
Authorized Official Telephone Number:
414-223-6874

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)