MEDICARE: VIVAWELL PHARMACY COMPANY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336L0003X	Long Term Care Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477299527
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIVAWELL PHARMACY COMPANY

Provider Business Mailing Address
First Line	:	72780 COUNTRY CLUB DR STE 403
Second Line	:
City	:	RANCHO MIRAGE
State	:	CA
Zip	:	92270-4149
Country	:	US
Telephone Number	:	760-610-6512
Fax Number	:	760-610-6981

Provider Business Practice Location Address
First Line	:	72780 COUNTRY CLUB DR STE 403
Second Line	:
City	:	RANCHO MIRAGE
State	:	CA
Zip	:	92270-4149
Country	:	US
Telephone Number	:	760-610-6512
Fax Number	:	760-610-6981

Authorized Official
Title or Position	:	CEO
Name	:	JASON B KIROYAN
Credential	:
Telephone Number	:	760-610-6512

Provider Enumeration Date	:	05/11/2022
Last Update Date	:	06/04/2026

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Directions to “VIVAWELL PHARMACY COMPANY ” Practice Location

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