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Organization
OLD ROSWELL HOLDINGS LLC
Active
Organization
OLD ROSWELL HOLDINGS LLC
Active
Other names
Medicine Shoppe 1518
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY EDEN (OWNER)
(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, ATLANTA, GA 30342-2281
(404) 459-8005
(404) 256-5517
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
3336L0003X
Long Term Care Pharmacy
Primary
—
NULL
Other
Enumeration date
01/29/2025
Last updated
04/23/2025
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