Provider Demographics
NPI:1336510726
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:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TALHA
Authorized Official - Middle Name:
Authorized Official - Last Name:WAQAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-966-4625
Mailing Address - Street 1:378 CAMBRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-1557
Mailing Address - Country:US
Mailing Address - Phone:866-966-4625
Mailing Address - Fax:
Practice Address - Street 1:811 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4148
Practice Address - Country:US
Practice Address - Phone:866-966-4625
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-12
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2154599OtherPK