Provider Demographics
NPI:1821453952
Name:EVORX LLC
Entity Type:Organization
Organization Name:EVORX LLC
Other - Org Name:EVOLUTION RX PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-481-4386
Mailing Address - Street 1:931 ELDRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-2809
Mailing Address - Country:US
Mailing Address - Phone:832-532-7961
Mailing Address - Fax:832-532-7987
Practice Address - Street 1:931 ELDRIDGE RD
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-2809
Practice Address - Country:US
Practice Address - Phone:832-532-7961
Practice Address - Fax:832-532-7987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-16
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30616333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX148452Medicaid
2157240OtherPK
2157240OtherPK