Healthcare Provider Details

I. General information

NPI: 1679482160
Provider Name (Legal Business Name): LANCE LINDERMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24276 166TH ST
EAGLE BUTTE SD
57625-8141
US

IV. Provider business mailing address

PO BOX 165
TIMBER LAKE SD
57656-0165
US

V. Phone/Fax

Practice location:
  • Phone: 605-964-7724
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5971
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: