NPIMap

Organization Active NPI

Old Roswell Holdings LLC

  • Community/Retail Pharmacy
  • Binghamton, NY
National Provider Identifier
1083722151
Registry record updated Apr 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
OLD ROSWELL HOLDINGS LLC
Practice address
1179 Vestal Ave
Ste. 1
Binghamton, NY 13903-1606
Phone
(607) 723-7585
Fax
(607) 773-0936
NPI assigned
Aug 28, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tracy Eden
Title
Manager
Phone
(404) 459-8005

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 024755 NY
Community/Retail Pharmacy 3336C0003X NY Primary

Addresses

Primary practice location

1179 Vestal Ave
Ste. 1
Binghamton, NY 13903-1606

Mailing address

5064 Roswell Rd Ste A200
Atlanta, GA 30342-2252
Phone (404) 459-8005

Other identifiers 2

IdentifierTypeStateIssuer
3327637OtherNYNCPDP #
02734325MedicaidNY

Other names 1

  • THE MEDICINE SHOPPE Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20090622000252 NY Part B Supplier - Mass Immunization (Roster Biller Only) 6002994696 2 other NPIs on this enrollment
Practice locations: Binghamton, NY
O20250701003005 NY DME Supplier - Pharmacy 0840701348 Practice locations: Binghamton, NY
O20250709002018 NY Part B Supplier - Mass Immunization (Roster Biller Only) 0840701348 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Binghamton, NY

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
CL Cressler Inc10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

1179 Vestal Ave
Binghamton, NY 13903

1179 Vestal Ave
#1
Binghamton, NY 13903
Phone (607) 723-7584

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745884800000",
    "number": "1083722151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5064 ROSWELL RD STE A200",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303422252",
            "telephone_number": "404-459-8005",
            "fax_number": "404-256-5517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1179 VESTAL AVE",
            "address_2": "STE. 1",
            "city": "BINGHAMTON",
            "state": "NY",
            "postal_code": "139031606",
            "telephone_number": "607-723-7585",
            "fax_number": "607-773-0936"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLD ROSWELL HOLDINGS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-28",
        "last_updated": "2025-04-29",
        "certification_date": "2025-03-31",
        "status": "A",
        "authorized_official_last_name": "EDEN",
        "authorized_official_first_name": "TRACY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "404-459-8005"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NY",
            "license": "024755",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP #",
            "identifier": "3327637",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02734325",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "THE MEDICINE SHOPPE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "THE MEDICINE SHOPPE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Binghamton, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.