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ROSE CITY PHARMACY LLC
NPI 1194317289
Pharmacy - Long Term Care Pharmacy in Tyler, TX

Active since February 09, 2021
2130 W GRANDE BLVD, TYLER, TX 75703(903) 707-2034(903) 707-2036 Get Directions Write a Review

NPPES record last updated: April 16, 2021. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Apr 16, 2021, Feb 9, 2021 (2 updates tracked since 2021).

About Rose City Pharmacy Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ROSE CITY PHARMACY LLC (NPI 1194317289) is a healthcare organization registered as a long term care pharmacy in Tyler, Texas and active in the NPI registry since February 2021. The organization lists Wilson L Krezdorn, President/pharmacist, as its authorized official.

NPPES Registry Identity

NPI1194317289
Entity TypeOrganization
Primary Taxonomy3336L0003X
Legal Business NameROSE CITY PHARMACY LLC
Location Address2130 W GRANDE BLVDTyler, TX 75703-0563
Mailing Address2130 W Grande BlvdTyler, TX 75703-0563 · (903) 707-2034 · Fax (903) 707-2036
Phone(903) 707-2034
Fax(903) 707-2036
Organization SubpartNo
Authorized OfficialWilson L KrezdornPresident/pharmacist · (903) 707-2034
Enumeration DateFebruary 9, 2021
Last NPPES UpdateApril 16, 20212 updates tracked since enumeration
NPPES CertifiedApril 16, 2021
✔ NPI 1194317289 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPharmacy · Long Term Care PharmacySuppliers
Taxonomy Code3336L0003X
Definition
A pharmacy that dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements.
2130 W GRANDE BLVD, Tyler, TX 75703
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Other Identifiers 1

Medicaid149679TX

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Moda Health Plan, Inc..Insurance ›

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. WILSON LEE KREZDORN PHARM.D.
Pharmacist
2130 W GRANDE BLVD
TYLER, TX 75703
Smith County (903) 707-2034
ROSE CITY PHARMACY LLC
Pharmacy (Community/Retail Pharmacy)
2130 W GRANDE BLVD
TYLER, TX 75703
Smith County (903) 707-2034

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Rose City Pharmacy LLC's NPI number?

The NPI number for Rose City Pharmacy LLC is 1194317289. It was assigned to this organization in the NPPES registry on February 9, 2021.

Where is Rose City Pharmacy LLC located?

Rose City Pharmacy LLC is located at 2130 W Grande Blvd, Tyler, TX 75703. The listed phone number is (903) 707-2034.

What is Rose City Pharmacy LLC's specialty?

The primary specialty registered for this NPI is Pharmacy, specializing in Long Term Care Pharmacy, with taxonomy code 3336L0003X.

What insurance does Rose City Pharmacy LLC accept?

Health plans from Moda Health Plan, Inc. list Rose City Pharmacy LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Rose City Pharmacy LLC was last updated on April 16, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.