Old Roswell Holdings LLC

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

License

027659 Issued in NY

Legal business name

OLD ROSWELL HOLDINGS LLC

Doing business as

The Medicine Shoppe

Practice address

1179 Vestal Ave
Ste. 2
Binghamton, NY 13903-1606

Phone

(607) 217-4845

Fax

(607) 217-5061

NPI assigned

Aug 28, 2006

Last updated

Apr 29, 2025By the provider in NPPES

Organization subpart

No

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 1

Addresses

Other names 1

• THE MEDICINE SHOPPE Doing business as

Medicare fee-for-service enrollment

Enrolled in NY3 enrollments

Enrollment records 3

Other NPIs with the same Medicare PAC ID 4

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

• Old Roswell Holdings LLC

  dba The Medicine Shoppe

  • Community/Retail Pharmacy
  • Binghamton, NY
  • NPI 1083722151

  0840701348

  Same PAC ID
• Old Roswell Holdings LLC

  dba The Medicine Shoppe

  • Long Term Care Pharmacy
  • Pittsburgh, PA
  • NPI 1215031877

  0840701348

  Same PAC ID
• Old Roswell Holdings LLC

  dba The Medicine Shoppe Pharmacy

  • Community/Retail Pharmacy
  • Mechanicsburg, PA
  • NPI 1285058651

  0840701348

  Same PAC ID
• Old Roswell Holdings LLC

  dba Medicine Shoppe

  • Long Term Care Pharmacy
  • Camp Hill, PA
  • NPI 1619240025

  0840701348

  Same PAC ID

Other NPIs on the same Medicare enrollment 1

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

• Old Roswell Holdings LLC

  dba The Medicine Shoppe

  • Community/Retail Pharmacy
  • Binghamton, NY
  • NPI 1083722151

  O20090622000252, O20250709002018

  Same enrollment

Locations

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": "1124136296",
    "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. 2",
            "city": "BINGHAMTON",
            "state": "NY",
            "postal_code": "139031606",
            "telephone_number": "607-217-4845",
            "fax_number": "607-217-5061"
        }
    ],
    "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": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "NY",
            "license": "027659",
            "primary": true
        }
    ],
    "identifiers": [],
    "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"
        }
    ]
}

• Ferdinard C Ojobor, PHARMACIST
• Maryam Okhravi
• Kathleen Olbrys, NP
• Ryan M Olbrys, DDS
• Old Roswell Holdings LLC (The Medicine Shoppe)
• Old Roswell Holdings LLC (The Medicine Shoppe)
• Old Roswell Holdings LLC (Medicine Shoppe 1518)
• Old Roswell Holdings LLC (Medicine Shoppe 1517C)
• Old Roswell Holdings LLC (Medicine Shoppe 1517)
• Shital Oli, MD

• Long Term Care Pharmacy in Binghamton, NY
• Providers in Binghamton, NY by specialty
• Long Term Care Pharmacy in New York

• 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.