# ROSE CITY PHARMACY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194317289
- **Authorized official:** WILSON L KREZDORN PHARMD (PRESIDENT/PHARMACIST)
- **Authorized official phone:** (903) 707-2034

## Contact information

- **Practice address:** 2130 W GRANDE BLVD, TYLER, TX 75703-0563
- **Practice address phone:** (903) 707-2034
- **Practice address fax:** (903) 707-2036
- **Mailing address:** 2130 W GRANDE BLVD, TYLER, TX 75703-0563
- **Mailing address phone:** (903) 707-2034
- **Mailing address fax:** (903) 707-2036

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 02/09/2021
- **Last updated:** 04/16/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 149679 | — | TX |