Provider Demographics
NPI:1144557448
Name:KREZDORN, WILSON LEE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:WILSON
Middle Name:LEE
Last Name:KREZDORN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:SONNY
Other - Middle Name:
Other - Last Name:KREZDORN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:18248 SPRINGMILL CT
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:TX
Mailing Address - Zip Code:75762-5000
Mailing Address - Country:US
Mailing Address - Phone:903-952-1698
Mailing Address - Fax:
Practice Address - Street 1:2130 W GRANDE BLVD
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-0563
Practice Address - Country:US
Practice Address - Phone:903-707-2034
Practice Address - Fax:903-707-2036
Is Sole Proprietor?:No
Enumeration Date:2009-11-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist