Organization
OLD ROSWELL HOLDINGS LLC
Active
Other names
The Medicine Shoppe Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY EDEN (MANAGER)
(404) 459-8005
Entity
Organization
Contact information
Practice address
5225 WILSON LN, MECHANICSBURG, PA 17055-6663
(717) 516-3103
(717) 516-3104
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
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PP481129
PA
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2144834
PK
—
Enumeration date
02/06/2014
Last updated
04/29/2025
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