Organization
MSM HOLDCO, LLC
Active
Other names
Martins Super Markets Inc, Martin's Pharmacy #2304, Martins Pharmacy #4
Organization subpart
No
Provider details
NPI number
Authorized official
AMY ELLIS RPH (DIRECTOR OF PHARMACY)
(616) 878-2848
Entity
Organization
Contact information
Practice address
314 N IRONWOOD DR, MISHAWAKA, IN 46544-1543
(574) 254-2323
(574) 254-2320
Mailing address
1527 MOMENTUM PLACE, CHICAGO, IL 60689-5315
(616) 878-8584
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
60006166A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1562330
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
10/06/2008
Last updated
01/08/2024
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