Organization
MSM HOLDCO, LLC
Active
Other names
Martins Super Markets Inc, Martins Pharmacy #15, Martin's Pharmacy #2315
Organization subpart
No
Provider details
NPI number
Authorized official
AMY ELLIS RPH (DIRECTOR OF PHARMACY)
(616) 878-2848
Entity
Organization
Contact information
Practice address
120 SANFORD SCHOOL RD, STE B, ELKHART, IN 46514
(574) 970-6470
Mailing address
1527 MOMENTUM PLACE, CHICAGO, IL 60689-5315
(616) 878-8584
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
60006210A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1562823
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
12/19/2009
Last updated
12/07/2023
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