Provider Demographics
NPI:1033117510
Name:MAPLE HILL, INC.
Entity Type:Organization
Organization Name:MAPLE HILL, INC.
Other - Org Name:FOSTERS PHARMACY OF CENTERBURG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHILDERS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:740-625-7626
Mailing Address - Street 1:4584 COLUMBUS RD
Mailing Address - Street 2:
Mailing Address - City:CENTERBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43011-9401
Mailing Address - Country:US
Mailing Address - Phone:740-625-7626
Mailing Address - Fax:740-625-7640
Practice Address - Street 1:4584 COLUMBUS RD
Practice Address - Street 2:
Practice Address - City:CENTERBURG
Practice Address - State:OH
Practice Address - Zip Code:43011-9401
Practice Address - Country:US
Practice Address - Phone:740-625-7626
Practice Address - Fax:740-625-7640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH42018117332B00000X
OH0208396503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0144570Medicaid
OH3661130OtherNABP NUMBER
OH1057230001Medicare NSC