Healthcare Provider Details

I. General information

NPI: 1922513506
Provider Name (Legal Business Name): NIMBLE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2017
Last Update Date: 04/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 JERROLD AVE STE Q
SAN FRANCISCO CA
94124-1034
US

IV. Provider business mailing address

2200 JERROLD AVE STE Q
SAN FRANCISCO CA
94124-1034
US

V. Phone/Fax

Practice location:
  • Phone: 866-966-4625
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: EVA ONG
Title or Position: PROJECT COORDINATOR
Credential:
Phone: 866-966-4625