Organization
MSM HOLDCO, LLC
Active
Other names
Martin's Pharmacy at SJRMC, Martin's Super Markets Inc, Martin's Pharmacy #2389
Organization subpart
No
Provider details
NPI number
Authorized official
AMY ELLIS RPH (DIRECTOR OF PHARMACY)
(616) 878-2848
Entity
Organization
Contact information
Practice address
611 E DOUGLAS RD STE 104, MISHAWAKA, IN 46545-1480
(574) 247-1000
(574) 208-6020
Mailing address
1527 MOMENTUM PLACE, CHICAGO, IL 60689-5315
(616) 878-8584
(574) 208-6020
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
60006269A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2163717
PK
—
Enumeration date
09/07/2016
Last updated
12/07/2023
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