Provider Demographics
NPI:1003942673
Name:MAPLE LEAF COMM PHARMACY
Entity Type:Organization
Organization Name:MAPLE LEAF COMM PHARMACY
Other - Org Name:MAPLE LEAF HOME HEALTH CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:JERKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-239-7560
Mailing Address - Street 1:3433 AGLER RD
Mailing Address - Street 2:SUITE 1500
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-3387
Mailing Address - Country:US
Mailing Address - Phone:614-239-7560
Mailing Address - Fax:614-239-7946
Practice Address - Street 1:3433 AGLER RD
Practice Address - Street 2:SUITE 1500
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-3387
Practice Address - Country:US
Practice Address - Phone:614-239-7560
Practice Address - Fax:614-239-7946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2278379Medicaid
OH4554460001Medicare NSC