Provider Demographics
NPI:1750699179
Name:EVOLUTION PHARMACY SERVICE INC
Entity type:Organization
Organization Name:EVOLUTION PHARMACY SERVICE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:
Authorized Official - Last Name:SAUTER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:570-534-0995
Mailing Address - Street 1:401 LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:PITTSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18640-3557
Mailing Address - Country:US
Mailing Address - Phone:570-534-0995
Mailing Address - Fax:570-299-7896
Practice Address - Street 1:401 LAUREL ST
Practice Address - Street 2:
Practice Address - City:PITTSTON
Practice Address - State:PA
Practice Address - Zip Code:18640-3557
Practice Address - Country:US
Practice Address - Phone:570-534-0995
Practice Address - Fax:570-299-7896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-20
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP4820453336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2126766OtherPK