Provider Demographics
NPI:1255827986
Name:NIMBLE PHARMACY, INC
Entity Type:Organization
Organization Name:NIMBLE PHARMACY, INC
Other - Org Name:NIMBLE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROJECT COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:EVA
Authorized Official - Middle Name:
Authorized Official - Last Name:ONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-966-4625
Mailing Address - Street 1:1134 CRANE ST STE 100
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-4329
Mailing Address - Country:US
Mailing Address - Phone:866-966-4625
Mailing Address - Fax:650-889-4199
Practice Address - Street 1:4601 LANGLAND RD STE 105
Practice Address - Street 2:
Practice Address - City:FARMERS BRANCH
Practice Address - State:TX
Practice Address - Zip Code:75244-8235
Practice Address - Country:US
Practice Address - Phone:866-966-4625
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NIMBLE PHARMACY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-05
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX321463336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy