Organization
MSM HOLDCO, LLC
Active
Other names
Martin's Pharmacy #2326, 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
1150 HUSKY TRL, WARSAW, IN 46582-1952
(574) 371-9080
(574) 371-9081
Mailing address
1527 MOMENTUM PLACE, CHICAGO, IL 60689-5315
(616) 878-8584
(574) 371-9081
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
60006233A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1563089
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
09/15/2010
Last updated
12/07/2023
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