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General NPI Number Information
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NPI Number | 1871788265
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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 | 09/10/2007
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 2575 W BROAD ST STE 5
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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 | 614-274-5890
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Fax | 614-274-5899
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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 | 614-274-5890
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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 | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PMY.021746200-03
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License Number State | OH
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