# VIVAWELL PHARMACY COMPANY

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** VIVAWELL PHARMACY COMPANY
- **Other names:** VivaRx LTC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1477299527
- **Legal business name:** VIVAWELL PHARMACY COMPANY
- **Authorized official:** JASON B KIROYAN (CEO)
- **Authorized official phone:** (760) 610-6512

## Contact information

- **Practice address:** 72780 COUNTRY CLUB DR STE 403, RANCHO MIRAGE, CA 92270-4149
- **Practice address phone:** (760) 610-6512
- **Practice address fax:** (760) 610-6981
- **Mailing address:** 72780 COUNTRY CLUB DR STE 403, RANCHO MIRAGE, CA 92270-4149
- **Mailing address phone:** (760) 610-6512
- **Mailing address fax:** (760) 610-6981

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 05/11/2022
- **Last updated:** 06/04/2026

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1396107249 | — | CA |