MSM Holdco, LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

MSM HOLDCO, LLC

Doing business as

Martin's Pharmacy #2306
Martin's Pharmacy #6

Practice address

3800 E Mishawaka Rd
Elkhart, IN 46517-3540

Phone

(574) 875-9423

NPI assigned

Nov 3, 2006

Last updated

Dec 7, 2023By the provider in NPPES

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 identifiers 1

Other names 3

• Martin's Pharmacy #2306 Doing business as
• Martin's Pharmacy #6 Doing business as
• Martin's Super Markets, Inc. Former legal business name

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Martin's Super Markets of St. Joseph, LLC

  dba Martin's Pharmacy #21

  • Community/Retail Pharmacy
  • Saint Joseph, MI
  • NPI 1396824116

  Member Of

  NPD member

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

• Martin's Super Markets of St. Joseph, LLC

  dba Martin's Pharmacy #21

  • Community/Retail Pharmacy
  • Saint Joseph, MI
  • NPI 1396824116

  Member Of

  NPD member

Locations

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": "1699854497",
    "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": "3800 E MISHAWAKA RD",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465173540",
            "telephone_number": "574-875-9423"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MSM HOLDCO, 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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200376290A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Martin's Pharmacy #2306",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Martin's Pharmacy #6",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Martin's Super Markets, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Julie B Motycka, MD
• MP Health PC
• MP Supports LLC
• Lacy Mroz, DPT
• MSM Holdco, LLC (Martin's Pharmacy #2315)
• Kelsey Mueller
• Peter Mugetha, A-GNP-C
• Delaney Murphy, RBT
• Angela A Murray, M.A.
• Abdurrahman Mustafa, MD

• Community/Retail Pharmacy in Elkhart, IN
• Providers in Elkhart, IN by specialty
• Community/Retail Pharmacy in Indiana

• 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.