NPIMap

Organization Active NPI

MSM Holdco, LLC

Doing business as Martin's Pharmacy #2326

  • Community/Retail Pharmacy
  • Warsaw, IN
National Provider Identifier
1891003661
Registry record updated Dec 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
60006233A Issued in IN
Legal business name
MSM HOLDCO, LLC
Doing business as
Martin's Pharmacy #2326
Practice address
1150 Husky TRL
Warsaw, IN 46582-1952
Phone
(574) 371-9080
Fax
(574) 371-9081
NPI assigned
Sep 15, 2010
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 60006233A IN Primary

Addresses

Primary practice location

1150 Husky TRL
Warsaw, IN 46582-1952

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
1563089OtherNCPDP PROVIDER IDENTIFICATION NUMBER

Other names 2

  • Martin's Pharmacy #2326 Doing business as
  • Martin's 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

1150 Husky Trl
Warsaw, IN 46582
Phone (574) 371-9080

Practitioners & affiliated clinicians

Practitioners 1

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": "1284508800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701907200000",
    "number": "1891003661",
    "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",
            "fax_number": "574-371-9081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 HUSKY TRL",
            "city": "WARSAW",
            "state": "IN",
            "postal_code": "465821952",
            "telephone_number": "574-371-9080",
            "fax_number": "574-371-9081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MSM HOLDCO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-15",
        "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": "60006233A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "1563089",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Martin's Pharmacy #2326",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Martin's Super Markets, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Warsaw, 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.