# OLD ROSWELL HOLDINGS LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** THE MEDICINE SHOPPE
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215031877
- **Authorized official:** TRACY EDEN (MANAGER)
- **Authorized official phone:** (404) 459-8005

## Contact information

- **Practice address:** 1101 PARKWAY VIEW DR, PITTSBURGH, PA 15205-1425
- **Practice address phone:** (412) 697-4880
- **Practice address fax:** (412) 697-4897
- **Mailing address:** 5064 ROSWELL RD STE A200, ATLANTA, GA 30342-2252
- **Mailing address phone:** (404) 459-8005
- **Mailing address fax:** (404) 256-5517

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | PP411059L | PA | Yes |

## Other

- **Enumeration date:** 09/12/2006
- **Last updated:** 04/29/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0018224450014 | — | PA |
| 01 | — | 3962102 | NCPDP \# | PA |