Organization
ROSE CITY PHARMACY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILSON L KREZDORN PHARMD (PRESIDENT/PHARMACIST)
(903) 707-2034
Entity
Organization
Contact information
Practice address
2130 W GRANDE BLVD, TYLER, TX 75703-0563
(903) 707-2034
(903) 707-2036
Mailing address
2130 W GRANDE BLVD, TYLER, TX 75703-0563
(903) 707-2034
(903) 707-2036
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
149679
—
TX
Enumeration date
02/09/2021
Last updated
04/16/2021
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