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
1101 PARKWAY VIEW DR, PITTSBURGH, PA 15205-1425
(412) 697-4880
(412) 697-4897
Mailing address
5064 ROSWELL RD STE A200, ATLANTA, GA 30342-2252
(404) 459-8005
(404) 256-5517
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336L0003X
Long Term Care Pharmacy
Primary
PP411059L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0018224450014
—
PA
01
—
3962102
NCPDP #
PA
Enumeration date
09/12/2006
Last updated
04/29/2025
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