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Organization

OLD ROSWELL HOLDINGS LLC

Active
Other names
Medicine Shoppe 1517
Organization subpart
No

Provider details

NPI number
Authorized official
TRACY EDEN (OWNER)
(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, ATLANTA, GA 30342-2281
(404) 459-8005
(404) 256-5517

Taxonomy

Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
3336C0003X
Community/Retail Pharmacy
Primary

Other

Enumeration date
01/29/2025
Last updated
04/23/2025
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