NPIMap

Organization Active NPI

Old Roswell Holdings LLC

Doing business as The Medicine Shoppe

  • Long Term Care Pharmacy
  • Pittsburgh, PA
National Provider Identifier
1215031877
Registry record updated Apr 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
License
PP411059L Issued in PA
Legal business name
OLD ROSWELL HOLDINGS LLC
Doing business as
The Medicine Shoppe
Practice address
1101 Parkway View Dr
Pittsburgh, PA 15205-1425
Phone
(412) 697-4880
Fax
(412) 697-4897
NPI assigned
Sep 12, 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
Durable Medical Equipment & Medical Supplies 332B00000X
Long Term Care Pharmacy 3336L0003X PP411059L PA Primary

Addresses

Primary practice location

1101 Parkway View Dr
Pittsburgh, PA 15205-1425

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
0018224450014MedicaidPA
3962102OtherPANCPDP #

Other names 1

  • THE MEDICINE SHOPPE Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20250612002319 PA Part B Supplier - Mass Immunization (Roster Biller Only) 0840701348 2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Pittsburgh, PA; Mechanicsburg, PA; Camp Hill, PA
O20250710001156 PA DME Supplier - Pharmacy 0840701348 Practice locations: Pittsburgh, PA

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 2

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

National Provider Directory

National Provider Directory

Locations

5064 Roswell Rd
Ste A200
Sandy Springs, GA 30342

330 S 9th St
Ste 180
Pittsburgh, PA 15203
Phone (412) 697-4880

1101 Parkway View Dr
Pittsburgh, PA 15205
Phone (412) 697-4880

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1158019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745884800000",
    "number": "1215031877",
    "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": "1101 PARKWAY VIEW DR",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "152051425",
            "telephone_number": "412-697-4880",
            "fax_number": "412-697-4897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLD ROSWELL HOLDINGS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-12",
        "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": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "PA",
            "license": "PP411059L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0018224450014",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP #",
            "identifier": "3962102",
            "state": "PA"
        }
    ],
    "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 Pittsburgh, PA

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.