Active NPI
MSM Holdco, LLC
Doing business as Martin's Pharmacy #16
- Community/Retail Pharmacy
- Granger, IN
National Provider Identifier
1225220528
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 60006073A
- Legal business name
- MSM HOLDCO, LLC
- Doing business as
- Martin's Pharmacy #16
Martin's Pharmacy #2316 - Practice address
- 12850 State Road 23
Granger, IN 46530-7183 - Phone
- (574) 807-8234
- Fax
- (574) 807-8232
- NPI assigned
- Aug 10, 2007
- Last updated
- Jan 8, 2024
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Amy Ellis, RPH
- Title
- Director of Pharmacy
- Phone
- (616) 878-2848
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | 60006073A | IN | Primary |
Addresses
Primary practice location
12850 State Road 23
Granger, IN 46530-7183
Mailing address
1527 Momentum Place
Chicago, IL 60689-5315
Phone (616) 878-8584
Other names 3
- Martin's Pharmacy #16
- Martin's Pharmacy #2316
- Martin's Super Market, Inc.
National Provider Directory
National Provider Directory- Tax ID family
- Martin's Pharmacy 11
Other organizations with this tax ID 10
Organizations that report the same tax identification number in the National Provider Directory.
Locations
12850 State Road 23
Granger, IN 46530
Phone (574) 807-8233
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Pharmacist
- Granger, IN
- NPI 1972190254
-
- Pharmacist
- Granger, IN
- NPI 1093933921
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1186704000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1704672000000",
"number": "1225220528",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1527 MOMENTUM PLACE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606895315",
"telephone_number": "616-878-8584"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12850 STATE ROAD 23",
"city": "GRANGER",
"state": "IN",
"postal_code": "465307183",
"telephone_number": "574-807-8234",
"fax_number": "574-807-8232"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MSM HOLDCO, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2007-08-10",
"last_updated": "2024-01-08",
"certification_date": "2024-01-08",
"status": "A",
"authorized_official_last_name": "ELLIS",
"authorized_official_first_name": "AMY",
"authorized_official_title_or_position": "DIRECTOR OF PHARMACY",
"authorized_official_telephone_number": "616-878-2848",
"authorized_official_credential": "RPH"
},
"taxonomies": [
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "IN",
"license": "60006073A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Martin's Pharmacy #16",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Martin's Pharmacy #2316",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Martin's Super Market, Inc.",
"code": "4",
"type": "Former Legal Business Name"
}
]
}Other providers in Granger, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.