MEDICARE: MAPLE LEAF COMM PHARMACY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist		OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003942673
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAPLE LEAF COMM PHARMACY

Provider Business Mailing Address
First Line	:	3433 AGLER RD
Second Line	:	SUITE 1500
City	:	COLUMBUS
State	:	OH
Zip	:	43219-3387
Country	:	US
Telephone Number	:	614-239-7560
Fax Number	:	614-239-7946

Provider Business Practice Location Address
First Line	:	3433 AGLER RD
Second Line	:	SUITE 1500
City	:	COLUMBUS
State	:	OH
Zip	:	43219-3387
Country	:	US
Telephone Number	:	614-239-7560
Fax Number	:	614-239-7946

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOSEPH JERKINS
Credential	:
Telephone Number	:	614-239-7560

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	08/22/2020

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Directions to “MAPLE LEAF COMM PHARMACY ” Practice Location

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