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
—
—
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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