Rose City Pharmacy Llc

LBN: Rose City Pharmacy Llc
Rose City Pharmacy Llc is an health care organization with primary practice located at 2130 W Grande Blvd , Tyler TX 75703-0563. The organization recently has only one registered license in Suppliers / Long Term Care Pharmacy, which is considered as the primary health care specialty. Rose City Pharmacy Llc can be contacted via phone (903) 707-2034, or through Krezdorn, Wilson L via phone (903) 707-2034.

Contact Information

Primary practice address
2130 W Grande Blvd Tyler TX 75703-0563
Phone: (903) 707-2034
Fax: (903) 707-2036
Website:
Map and Directions
Authorized official contact:
Name: Krezdorn, Wilson L PHARMD
Phone: (903) 707-2034

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Long Term Care Pharmacy 3336L0003X

Profile Details

NPI number 1194317289
LBN Legal business name Rose City Pharmacy Llc
DBA Doing business as
Authorized official Krezdorn, Wilson L PHARMD
Entity Organization
Organization subpart 1 No
Enumeration date Feb 9th, 2021
Last updated Apr 16th, 2021 - about 3 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1194317289 NPPES
Texas MEDICAID 149679

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