NPIMap

Organization Active NPI

MSM Holdco, LLC

Doing business as Martin's Pharmacy #2304

  • Community/Retail Pharmacy
  • Mishawaka, IN
National Provider Identifier
1366693665
Registry record updated Jan 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
60006166A Issued in IN
Legal business name
MSM HOLDCO, LLC
Doing business as
Martin's Pharmacy #2304
Martins Pharmacy #4
Practice address
314 N Ironwood Dr
Mishawaka, IN 46544-1543
Phone
(574) 254-2323
Fax
(574) 254-2320
NPI assigned
Oct 6, 2008
Last updated
Jan 8, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 8, 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 60006166A IN Primary

Addresses

Primary practice location

314 N Ironwood Dr
Mishawaka, IN 46544-1543

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
1562330OtherNCPDP PROVIDER IDENTIFICATION NUMBER

Other names 3

  • Martin's Pharmacy #2304 Doing business as
  • Martins Pharmacy #4 Doing business as
  • Martins Super Markets 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

314 N Ironwood Dr
Mishawaka, IN 46544
Phone (574) 254-2323

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": "1223251200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704672000000",
    "number": "1366693665",
    "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": "314 N IRONWOOD DR",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465441543",
            "telephone_number": "574-254-2323",
            "fax_number": "574-254-2320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MSM HOLDCO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-06",
        "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": "60006166A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "1562330",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Martin's Pharmacy #2304",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Martins Pharmacy #4",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Martins Super Markets Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Mishawaka, 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.

Verify at the official NPI Registry.