Rose City Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

31557 Issued in TX

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

Aug 29, 2017

Organization subpart

No

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

Authorized official

Name

Wilson Lee Krezdorn, PHARMD

Title

Owner

Phone

(903) 707-2034

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX2 enrollments

Enrollment records 2

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

{
    "created_epoch": "1503964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1780101816",
    "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": "2017-08-29",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "KREZDORN",
        "authorized_official_first_name": "WILSON",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "903-707-2034",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "TX",
            "license": "31557",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TX",
            "license": "31557",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rose City Birth Center
• 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
• Taylor Marie Rose, RN

• Community/Retail Pharmacy in Tyler, TX
• Providers in Tyler, TX by specialty
• Community/Retail Pharmacy 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.