Healthcare Provider Details

I. General information

NPI: 1396210290
Provider Name (Legal Business Name): JASON KIROYAN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2018
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72780 COUNTRY CLUB DR STE 403
RANCHO MIRAGE CA
92270-4149
US

IV. Provider business mailing address

72780 COUNTRY CLUB DR STE 403
RANCHO MIRAGE CA
92270-4149
US

V. Phone/Fax

Practice location:
  • Phone: 909-647-7354
  • Fax: 760-610-6512
Mailing address:
  • Phone: 909-647-7354
  • Fax: 760-610-6512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number79355
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: