Organization
MSM HOLDCO, LLC
Active
Other names
Martin's Super Market, Inc., Martin's Pharmacy #2316, Martin's Pharmacy #16
Organization subpart
No
Provider details
NPI number
Authorized official
AMY ELLIS RPH (DIRECTOR OF PHARMACY)
(616) 878-2848
Entity
Organization
Contact information
Practice address
12850 STATE ROAD 23, GRANGER, IN 46530-7183
(574) 807-8234
(574) 807-8232
Mailing address
1527 MOMENTUM PLACE, CHICAGO, IL 60689-5315
(616) 878-8584
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
60006073A
IN
Other
Enumeration date
08/10/2007
Last updated
01/08/2024
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