# MAPLE LEAF NEW ROME PHARMACY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912340795
- **Authorized official:** MR. JOSEPH JERKINS PHARM.D (OWNER)
- **Authorized official phone:** (614) 272-6791

## Contact information

- **Practice address:** 5212 W BROAD ST, COLUMBUS, OH 43228-1642
- **Practice address phone:** (614) 851-5811
- **Practice address fax:** (614) 851-5815
- **Mailing address:** PO BOX 27005, COLUMBUS, OH 43227-0005
- **Mailing address phone:** (614) 272-6791
- **Mailing address fax:** (614) 272-6826

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 022295450 | OH | Yes |

## Other

- **Enumeration date:** 04/11/2013
- **Last updated:** 04/11/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 022295450 | TERMINAL DISBRIBUTOR OF DANGEROUS DRUGS LICENSE | OH |