Wilson Lee Krezdorn | Tyler, TX • PECOS Search

Wilson Lee Krezdorn

Pharmacist

Pharmacy Service Providers

2130 W Grande Blvd, Tyler, TX 75703-0563

(903) 707-2034 (903) 952-1698

PECOS Enrollment

Based on the most recent information from CMS, provider Wilson Lee Krezdorn does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 12:57 PM.

Profile Details

Provider ID
1144557448
Provider Type
Individual
Full Name
Krezdorn, Wilson Lee
Title
Dr.
Credential
PHARM.D.

Gender
Male
Sole Proprietor
No
Enumeration Date
11/6/2009
Last Updated
7/21/2022

Contact Information

Practice Location

2130 W Grande Blvd, Tyler, TX 75703-0563

(903) 707-2036

Mailing Location

18248 Springmill Ct, Flint, TX 75762-5000

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 183500000X Primary	Description Pharmacist Pharmacy Service Providers	License 45300 Texas