Organization
ROSE CITY PHARMACY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILSON LEE KREZDORN PHARMD (OWNER)
(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
333600000X
Pharmacy
31557
TX
3336C0003X
Community/Retail Pharmacy
Primary
31557
TX
Other
Enumeration date
08/29/2017
Last updated
07/21/2022
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