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Organization
VIVAWELL PHARMACY COMPANY
Active
Organization
VIVAWELL PHARMACY COMPANY
Active
Other names
VivaRx Pharmacy, VivaRx
Organization subpart
No
Provider details
NPI number
Authorized official
JASON KIROYAN (CEO/CFO/SEC/DIR)
(909) 647-7354
Entity
Organization
Contact information
Practice address
72780 COUNTRY CLUB DR, STE 403, RANCHO MIRAGE, CA 92270-4149
(760) 610-6512
Mailing address
72780 COUNTRY CLUB DR, STE 403, RANCHO MIRAGE, CA 92270-4149
(760) 610-6512
(760) 610-6981
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
54279
CA
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1396107249
—
CA
01
—
2158852
PK
—
Enumeration date
03/21/2016
Last updated
06/09/2026
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