Healthcare Provider Details

I. General information

NPI: 1326730417
Provider Name (Legal Business Name): EVOLVE PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2023
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2423 MAIN ST STE 5
EVANSTON IL
60202-1547
US

IV. Provider business mailing address

710 N DEARBORN ST
CHICAGO IL
60654-5900
US

V. Phone/Fax

Practice location:
  • Phone: 615-928-2511
  • Fax: 615-928-2511
Mailing address:
  • Phone: 615-928-2511
  • Fax: 615-928-2511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES ROBERT SIMMONS
Title or Position: C.E.O
Credential:
Phone: 931-552-4340