Wilson Lee Krezdorn, PHARM.D.

Primary specialty

PharmacistTaxonomy code 183500000X

License

45300 Issued in TX

Practice address

2130 W Grande Blvd
Tyler, TX 75703-0563

Phone

(903) 707-2034

Fax

(903) 707-2036

NPI assigned

Nov 6, 2009

Last updated

Jul 21, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Sonny Krezdorn Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Pharmacy

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Rose City Pharmacy LLC

  • Long Term Care Pharmacy
  • Tyler, TX
  • NPI 1194317289
  Authorized official Same address or phone
• Rose City Pharmacy LLC

  • Community/Retail Pharmacy
  • Tyler, TX
  • NPI 1780101816
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1257465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1144557448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18248 SPRINGMILL CT",
            "city": "FLINT",
            "state": "TX",
            "postal_code": "757625000",
            "telephone_number": "903-952-1698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2130 W GRANDE BLVD",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757030563",
            "telephone_number": "903-707-2034",
            "fax_number": "903-707-2036"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5976 Old Jacksonville HWY",
            "address_purpose": "LOCATION",
            "city": "Tyler",
            "state": "TX",
            "postal_code": "75703",
            "country_code": "US",
            "telephone_number": "903-405-6215 x20",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KREZDORN",
        "first_name": "WILSON",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "PHARM.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-11-06",
        "last_updated": "2022-07-21",
        "certification_date": "2021-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "TX",
            "license": "45300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SONNY",
            "last_name": "KREZDORN",
            "credential": "PHARMD.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Kimberley Krauter
• Jake H Kreck, P.A.-C
• Russell Krenek
• Dennis Michael Kress, PTA
• Nicholas Kreyling, DO
• Teresa Kriechbaum
• Benjamin John Krog, MD
• April Kruger, COTA
• Gracelyn Hernandez Kuester
• Matthew L Kuhl, NRP

• Pharmacist in Tyler, TX
• Providers in Tyler, TX by specialty
• Pharmacist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.