# OLD ROSWELL HOLDINGS LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Medicine Shoppe 1518
- **Organization subpart:** No

## Provider details

- **NPI number:** 1275346769
- **Authorized official:** TRACY EDEN (OWNER)
- **Authorized official phone:** (404) 459-8005

## Contact information

- **Practice address:** 1179 VESTAL AVE STE 2, BINGHAMTON, NY 13903-1606
- **Practice address phone:** (607) 217-4845
- **Practice address fax:** (607) 217-5061
- **Mailing address:** 5064 ROSWELL RD, ATLANTA, GA 30342-2281
- **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 | — | NULL | Yes |

## Other

- **Enumeration date:** 01/29/2025
- **Last updated:** 04/23/2025