Healthcare Provider Details

I. General information

NPI: 1578039723
Provider Name (Legal Business Name): EVOLVE RX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2018
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1618 SCHADT AVE
WHITEHALL PA
18052-3702
US

IV. Provider business mailing address

1618 SCHADT AVE
WHITEHALL PA
18052-3702
US

V. Phone/Fax

Practice location:
  • Phone: 610-351-6337
  • Fax: 610-351-6338
Mailing address:
  • Phone: 610-351-6337
  • Fax: 610-351-6338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. NICK DESAI
Title or Position: PHARMACY MANAGER
Credential: PHARMD
Phone: 908-487-7150