# OLD ROSWELL HOLDINGS LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Medicine Shoppe 2009
- **Organization subpart:** No

## Provider details

- **NPI number:** 1669285151
- **Authorized official:** TRACY EDEN (OWNER)
- **Authorized official phone:** (404) 459-8005

## Contact information

- **Practice address:** 5225 WILSON LN, MECHANICSBURG, PA 17055-6663
- **Practice address phone:** (717) 516-3103
- **Practice address fax:** (717) 516-3104
- **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 | — |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

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