Provider Demographics
NPI:1619344850
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:SATTAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-966-4625
Mailing Address - Street 1:1134 CRANE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025
Mailing Address - Country:US
Mailing Address - Phone:866-966-4625
Mailing Address - Fax:866-966-4625
Practice Address - Street 1:900 WILLOW RD
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-2544
Practice Address - Country:US
Practice Address - Phone:866-966-4625
Practice Address - Fax:650-889-4199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-24
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
CA536203336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2153914OtherPK