Provider Demographics
NPI:1114359791
Name:PINGLE, NATHAN ALLAN (PHARMD)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:ALLAN
Last Name:PINGLE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:NATHANIEL
Other - Middle Name:ALLAN PALANI
Other - Last Name:PINGLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:3525 E LOUISE DR STE 401
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-6303
Mailing Address - Country:US
Mailing Address - Phone:208-322-1680
Mailing Address - Fax:
Practice Address - Street 1:3525 E LOUISE DR STE 401
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-6303
Practice Address - Country:US
Practice Address - Phone:208-322-1680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-06
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13793183500000X
IDP91441835C0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835C0206XPharmacy Service ProvidersPharmacistCardiology
No183500000XPharmacy Service ProvidersPharmacist