NPIMap

Organization Active NPI

Old Roswell Holdings LLC

Doing business as Medicine Shoppe 1518

  • Long Term Care Pharmacy
  • Binghamton, NY
National Provider Identifier
1275346769
Registry record updated Apr 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
Legal business name
OLD ROSWELL HOLDINGS LLC
Doing business as
Medicine Shoppe 1518
Practice address
1179 Vestal Ave Ste 2
Binghamton, NY 13903-1606
Phone
(607) 217-4845
Fax
(607) 217-5061
NPI assigned
Jan 29, 2025
Last updated
Apr 23, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2025

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

Authorized official

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Long Term Care Pharmacy 3336L0003X Primary

Addresses

Primary practice location

1179 Vestal Ave Ste 2
Binghamton, NY 13903-1606

Mailing address

5064 Roswell Rd
Atlanta, GA 30342-2281
Phone (404) 459-8005

Other names 1

  • Medicine Shoppe 1518 Doing business as

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.

NPI Registry JSON

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

{
    "created_epoch": "1738108800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745366400000",
    "number": "1275346769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5064 ROSWELL RD",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303422281",
            "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 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": "2025-01-29",
        "last_updated": "2025-04-23",
        "certification_date": "2025-04-23",
        "status": "A",
        "authorized_official_last_name": "EDEN",
        "authorized_official_first_name": "TRACY",
        "authorized_official_title_or_position": "OWNER",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medicine Shoppe 1518",
            "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 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.