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Organization
OLD ROSWELL HOLDINGS LLC
Active
Organization
OLD ROSWELL HOLDINGS LLC
Active
Other names
THE MEDICINE SHOPPE
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY EDEN (MANAGER)
(404) 459-8005
Entity
Organization
Contact information
Practice address
1179 VESTAL AVE, STE. 2, BINGHAMTON, NY 13903-1606
(607) 217-4845
(607) 217-5061
Mailing address
5064 ROSWELL RD STE A200, ATLANTA, GA 30342-2252
(404) 459-8005
(404) 256-5517
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
027659
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02728792
—
NY
01
—
3327601
NCPDP #
NY
Enumeration date
08/28/2006
Last updated
04/29/2025
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