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General NPI Number Information
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NPI Number | 1780961441
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Entity Type | Organization
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Legal Business Name | MAPLE LEAF HILLTOP PHARMACY
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Dates
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Enumeration Date | 11/09/2011
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Last Update Date | 11/09/2011
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Provider Practice Location Address
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Address Line | 2575 W BROAD ST
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City | COLUMBUS
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State | OH
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Zip | 43204-3333
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Country | US
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Telephone | 614-272-8188
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Fax | 614-272-8311
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Provider Business Mailing Address
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Address Line | 2575 W BROAD ST
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City | COLUMBUS
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State | OH
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Zip | 43204-3333
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Country | US
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Telephone | 614-272-8188
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Fax | 614-272-8311
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOSEPH A JERKINS
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Credential | PHARMD
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Telephone | 614-272-6791
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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 | 022170700
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License Number State | OH
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