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General NPI Number Information
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NPI Number | 1851586564
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Entity Type | Organization
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Legal Business Name | MAPLE LEAF GROUP
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Dates
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Enumeration Date | 09/06/2007
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Last Update Date | 11/26/2014
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Provider Practice Location Address
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Address Line | 2343 CLEVELAND AVE
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City | COLUMBUS
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State | OH
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Zip | 43211-1611
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Country | US
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Telephone | 614-261-0004
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Fax | 614-261-1075
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Provider Business Mailing Address
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Address Line | PO BOX 27005
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City | COLUMBUS
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State | OH
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Zip | 43227-0005
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Country | US
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Telephone | 614-301-4526
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Fax | 614-443-1020
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Authorized Official
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Title or Position | OWNER
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Name | JOSEPH JERKINS
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Credential | RPH
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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 | RPT021746150
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License Number State | OH
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