NPIMap

Organization Active NPI

MSM Holdco, LLC

Doing business as Martin's Pharmacy #22

  • Community/Retail Pharmacy
  • Plymouth, IN
National Provider Identifier
1366521189
Registry record updated May 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
60005667A Issued in IN
Legal business name
MSM HOLDCO, LLC
Doing business as
Martin's Pharmacy #22
Martin's Pharmacy #2322
Practice address
865 E Jefferson St
Plymouth, IN 46563-1847
Phone
(574) 936-7334
Fax
(866) 528-5774
NPI assigned
Nov 3, 2006
Last updated
May 7, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 7, 2024

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 60005667A IN Primary

Addresses

Primary practice location

865 E Jefferson St
Plymouth, IN 46563-1847

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
200377010AMedicaidIN

Other names 3

  • Martin's Pharmacy #22 Doing business as
  • Martin's Pharmacy #2322 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.

Locations

865 E Jefferson St
Plymouth, IN 46563
Phone (574) 936-4081

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.

NPI Registry JSON

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

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715040000000",
    "number": "1366521189",
    "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": "865 E JEFFERSON ST",
            "city": "PLYMOUTH",
            "state": "IN",
            "postal_code": "465631847",
            "telephone_number": "574-936-7334",
            "fax_number": "866-528-5774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MSM HOLDCO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-03",
        "last_updated": "2024-05-07",
        "certification_date": "2024-05-07",
        "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": "60005667A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200377010A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Martin's Pharmacy #22",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Martin's Pharmacy #2322",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Martin's Super Market Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Plymouth, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 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.

Verify at the official NPI Registry.