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NPI Code Detail

MEDICARE: MAPLE LEAF GROUP

MEDICARE: MAPLE LEAF GROUP
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
1333600000XPharmacy
23336C0003XCommunity/Retail PharmacyPMY.021746200-03OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22081077OTHERPK

General Provider Information

NPI Number : 1871788265
Entity Type Code : Organization
Provider Name (Legal Business Name) : MAPLE LEAF GROUP
Provider Business Mailing Address
First Line : PO BOX 27005
Second Line :
City : COLUMBUS
State : OH
Zip : 43227-0005
Country : US
Telephone Number : 614-274-5890
Fax Number : 614-443-1020
Provider Business Practice Location Address
First Line : 2575 W BROAD ST STE 5
Second Line :
City : COLUMBUS
State : OH
Zip : 43204-3333
Country : US
Telephone Number : 614-274-5890
Fax Number : 614-274-5899
Authorized Official
Title or Position : OWNER
Name : JOSEPH JERKINS
Credential : RPH
Telephone Number : 614-272-6791
Provider Enumeration Date : 09/10/2007
Last Update Date : 09/19/2025

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Directions to “MAPLE LEAF GROUP ” Practice Location

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