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. 1, BINGHAMTON, NY 13903-1606
(607) 723-7585
(607) 773-0936
Mailing address
5064 ROSWELL RD STE A200, ATLANTA, GA 30342-2252
(404) 459-8005
(404) 256-5517
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
024755
NY
3336C0003X
Community/Retail Pharmacy
Primary
—
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02734325
—
NY
01
—
3327637
NCPDP #
NY
Enumeration date
08/28/2006
Last updated
04/29/2025
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