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General NPI Number Information
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NPI Number | 1689753493
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Entity Type | Organization
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Legal Business Name | MARTIN'S SUPERMARKETS OF NAPPANEE LLC
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Dates
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Enumeration Date | 11/03/2006
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Last Update Date | 12/07/2023
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Provider Practice Location Address
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Address Line | 242 N OAKLAND AVE
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City | NAPPANEE
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State | IN
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Zip | 46550-2319
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Country | US
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Telephone | 574-773-7873
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Fax |
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Provider Business Mailing Address
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Address Line | 1527 MOMENTUM PLACE
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City | CHICAGO
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State | IL
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Zip | 60689-5315
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Country | US
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Telephone | 616-878-8584
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF PHARMACY
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Name | AMY ELLIS
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Credential | RPH
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Telephone | 616-878-2848
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 60005775A
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License Number State | IN
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