NPIMap

Organization Active NPI

MSM Holdco, LLC

Doing business as Martin's Pharmacy #2324

  • Community/Retail Pharmacy
  • Goshen, IN
National Provider Identifier
1346319290
Registry record updated Dec 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
60005914A Issued in IN
Legal business name
MSM HOLDCO, LLC
Doing business as
Martin's Pharmacy #2324
Martin's Pharmacy #24
Practice address
1527 Bashor Road
Goshen, IN 46528
Phone
(574) 533-5600
NPI assigned
Nov 7, 2006
Last updated
Dec 7, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2023

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)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 60005914A IN Primary

Addresses

Primary practice location

1527 Bashor Road
Goshen, IN 46528

Mailing address

1527 Momentum Place
Chicago, IL 60689-5315
Phone (616) 878-8584

Other names 3

  • Martin's Pharmacy #2324 Doing business as
  • Martin's Pharmacy #24 Doing business as
  • Martin's Super Market, Inc. Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Martin's Pharmacy 1111 organizations share this tax ID, including this one

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701907200000",
    "number": "1346319290",
    "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": "1527 BASHOR ROAD",
            "city": "GOSHEN",
            "state": "IN",
            "postal_code": "46528",
            "telephone_number": "574-533-5600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MSM HOLDCO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-07",
        "last_updated": "2023-12-07",
        "certification_date": "2023-12-07",
        "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": "60005914A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Martin's Pharmacy #2324",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Martin's Pharmacy #24",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Martin's Pharmacy #24",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Martin's Super Market, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Goshen, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.