Rose City Pharmacy LLC

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

Legal business name

ROSE CITY PHARMACY LLC

Practice address

2130 W Grande Blvd
Tyler, TX 75703-0563

Phone

(903) 707-2034

Fax

(903) 707-2036

NPI assigned

Feb 9, 2021

Organization subpart

No

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

Authorized official

Name

Wilson L Krezdorn, PHARMD

Title

President/Pharmacist

Phone

(903) 707-2034

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1612828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618531200000",
    "number": "1194317289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "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"
        },
        {
            "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": [],
    "basic": {
        "organization_name": "ROSE CITY PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-09",
        "last_updated": "2021-04-16",
        "certification_date": "2021-04-16",
        "status": "A",
        "authorized_official_last_name": "KREZDORN",
        "authorized_official_first_name": "WILSON",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT/PHARMACIST",
        "authorized_official_telephone_number": "903-707-2034",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "149679",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "https://www.rosecityrx.net",
            "affiliation": "N",
            "endpointDescription": "pharmacy website address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2130 W Grande Blvd",
            "city": "Tyler",
            "state": "TX",
            "country_code": "US",
            "postal_code": "757030563",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Rose City Counseling PLLC
• Rose City Home Health Services, Inc.
• Rose City Midwifery and Wellness, Inc
• Rose City Pharmacy LLC
• Rose City Rd, LLC
• Rose City Urology PLLC
• Rose Dental Care of Tyler
• Jackie Rose, MD

• Long Term Care Pharmacy in Tyler, TX
• Providers in Tyler, TX by specialty
• Long Term Care Pharmacy in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2021; 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.