Organization
OLD ROSWELL HOLDINGS LLC
Active
Other names
Medicine Shoppe
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY EDEN (MANAGER)
(404) 459-8005
Entity
Organization
Contact information
Practice address
3913 HARTZDALE DR, SUITE 1306, CAMP HILL, PA 17011-7845
(717) 766-6191
(717) 691-1052
Mailing address
5064 ROSWELL RD STE A200, ATLANTA, GA 30342-2252
(404) 459-8005
(404) 259-5517
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336L0003X
Long Term Care Pharmacy
Primary
PP481575
PA
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0018224450018
—
PA
Enumeration date
02/15/2012
Last updated
04/29/2025
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