Organization
MSM HOLDCO, LLC
Active
Organization
MSM HOLDCO, LLC
Active
Other names
Martin's Super Markets Inc, Martin's Pharmacy #2325, Martins Pharmacy #25
Organization subpart
No
Provider details
NPI number
Authorized official
AMY ELLIS RPH (DIRECTOR OF PHARMACY)
(616) 878-2848
Entity
Organization
Contact information
Practice address
7355 HERITAGE SQUARE DRIVE, GRANGER, IN 46530
(574) 807-8222
Mailing address
1527 MOMENTUM PLACE, CHICAGO, IL 60689-5315
(616) 878-8584
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
60005955A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200828840A
—
IN
Enumeration date
11/06/2006
Last updated
12/07/2023
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