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General NPI Number Information
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NPI Number | 1003942673
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Entity Type | Organization
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Legal Business Name | MAPLE LEAF COMM PHARMACY
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3433 AGLER RD SUITE 1500
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City | COLUMBUS
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State | OH
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Zip | 43219-3387
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Country | US
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Telephone | 614-239-7560
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Fax | 614-239-7946
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Provider Business Mailing Address
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Address Line | 3433 AGLER RD SUITE 1500
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City | COLUMBUS
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State | OH
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Zip | 43219-3387
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Country | US
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Telephone | 614-239-7560
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Fax | 614-239-7946
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOSEPH JERKINS
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Credential |
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Telephone | 614-239-7560
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number |
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License Number State | OH
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