Active NPI
Lyle L Lutman, PHARMD
- Pharmacist
- Langdon, ND
National Provider Identifier
1790898609
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 4748
- Practice address
- 805 3Rd St
Langdon, ND 58249-2625 - Phone
- (701) 256-3330
- Fax
- (701) 256-5720
- NPI assigned
- Aug 16, 2006
- Last updated
- Dec 11, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 4748 | ND | Primary |
Addresses
Primary practice location
805 3Rd St
Langdon, ND 58249-2625
Mailing address
805 3Rd St
Langdon, ND 58249-2625
Phone (701) 256-3330
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4748 | Other | ND | PHARMACY LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4748 | ND | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Langdon Drug Inc | Current | Accepting new patients |
Locations
805 3rd St
Langdon, ND 58249
Phone (701) 256-3330
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Northwood Drug
- Community/Retail Pharmacy
- Northwood, ND
- NPI 1063690774
-
dba Bottineau Clinic Pharmacy
- Community/Retail Pharmacy
- Bottineau, ND
- NPI 1285651984
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155686400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1576022400000",
"number": "1790898609",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "805 3RD ST",
"city": "LANGDON",
"state": "ND",
"postal_code": "582492625",
"telephone_number": "701-256-3330",
"fax_number": "701-256-5720"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "805 3RD ST",
"city": "LANGDON",
"state": "ND",
"postal_code": "582492625",
"telephone_number": "701-256-3330",
"fax_number": "701-256-5720"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUTMAN",
"first_name": "LYLE",
"middle_name": "L",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-16",
"last_updated": "2019-12-11",
"certification_date": "2019-12-11",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "ND",
"license": "4748",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHARMACY LICENSE",
"identifier": "4748",
"state": "ND"
}
],
"endpoints": [],
"other_names": []
}Other providers in Langdon, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.