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Organization
VIVAWELL PHARMACY COMPANY
Active
Organization
VIVAWELL PHARMACY COMPANY
Active
Parent organization
VIVAWELL PHARMACY COMPANY
Other names
VivaRx LTC
Organization subpart
Yes
Provider details
NPI number
Legal business name
VIVAWELL PHARMACY COMPANY
Authorized official
JASON B KIROYAN (CEO)
(760) 610-6512
Entity
Organization
Contact information
Practice address
72780 COUNTRY CLUB DR STE 403, RANCHO MIRAGE, CA 92270-4149
(760) 610-6512
(760) 610-6981
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
3336L0003X
Long Term Care Pharmacy
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1396107249
—
CA
Enumeration date
05/11/2022
Last updated
06/04/2026
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