Organization
MSM HOLDCO, LLC
Active
Other names
Martin's Pharmacy #6, Martin's Pharmacy #2306, Martin's Super Markets, Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
AMY ELLIS RPH (DIRECTOR OF PHARMACY)
(616) 878-2848
Entity
Organization
Contact information
Practice address
3800 E MISHAWAKA RD, ELKHART, IN 46517-3540
(574) 875-9423
Mailing address
1527 MOMENTUM PLACE, CHICAGO, IL 60689-5315
(616) 878-8584
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200376290A
—
IN
Enumeration date
11/03/2006
Last updated
12/07/2023
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