Provider Demographics
NPI:1235177221
Name:LANGDON DRUG INC
Entity Type:Organization
Organization Name:LANGDON DRUG INC
Other - Org Name:LANGDON COMMUNITY DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:LYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LUTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:701-256-3330
Mailing Address - Street 1:805 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LANGDON
Mailing Address - State:ND
Mailing Address - Zip Code:58249-2624
Mailing Address - Country:US
Mailing Address - Phone:701-256-3330
Mailing Address - Fax:701-256-5720
Practice Address - Street 1:805 3RD ST
Practice Address - Street 2:
Practice Address - City:LANGDON
Practice Address - State:ND
Practice Address - Zip Code:58249-2624
Practice Address - Country:US
Practice Address - Phone:701-256-3330
Practice Address - Fax:701-256-5720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND509332B00000X, 3336L0003X
NDPHARM5093336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND3503756OtherNABP
ND1454261Medicaid
ND5438100001Medicare NSC