Provider Demographics
NPI:1326730417
Name:EVOLVE PHARMACY LLC
Entity Type:Organization
Organization Name:EVOLVE PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-552-4340
Mailing Address - Street 1:710 N DEARBORN ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-5900
Mailing Address - Country:US
Mailing Address - Phone:615-928-2511
Mailing Address - Fax:615-928-2511
Practice Address - Street 1:2423 MAIN ST STE 5
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-1547
Practice Address - Country:US
Practice Address - Phone:615-928-2511
Practice Address - Fax:615-928-2511
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TENNESSEE ORTHOPAEDIC ALLIANCE, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-05-25
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL054.022456OtherILLINOIS PHARMACY LICENSE