Martin'S Super Markets of Niles LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

5301007539 Issued in MI

Legal business name

MARTIN'S SUPER MARKETS OF NILES LLC

Practice address

720 S 11TH St
Niles, MI 49120-3313

Phone

(269) 684-1418

Fax

(269) 684-1457

NPI assigned

Nov 3, 2006

Organization subpart

No

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

Addresses

Other names 2

• Martin's Pharmacy #19 Doing business as
• Martin's Pharmacy #2319 Doing business as

Locations

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• John S Burgess, RPH

  • Pharmacist
  • Niles, MI
  • NPI 1639766561
  NPD (past)
• Ahmad Yahya Kaakarli, PHARMD; RPH

  • Pharmacist
  • Niles, MI
  • NPI 1861296980
  NPD (past)
• Ross Francis Maroney, RPH

  • Pharmacist
  • Niles, MI
  • NPI 1316534381
  NPD (past)

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

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701907200000",
    "number": "1609955418",
    "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": "720 S 11TH ST",
            "city": "NILES",
            "state": "MI",
            "postal_code": "491203313",
            "telephone_number": "269-684-1418",
            "fax_number": "269-684-1457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARTIN'S SUPER MARKETS OF NILES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-03",
        "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": "MI",
            "license": "5301007539",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Martin's Pharmacy #19",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Martin's Pharmacy #2319",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Stephanie Marie Mann
• John-Phillip Thomas Markovic, MD
• Alex Markovich, MS PT
• Ross Francis Maroney, RPH
• Andrea Maxine Martin, PHARMD
• Kelly Martinczak, LLSW, LSW
• Mary Patricia McManmon MD PC
• Brianna Matamoros-Morales
• Victoria Matamoros-Morales
• Stephanie Mattison

• All providers in Niles, MI
• Community/Retail Pharmacy in Michigan

• 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.