Organization
MAPLE LEAF COMPOUNDING PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOSEPH JERKINS PHARM.D (OWNER/RESPONSIBLE PHARMACIST)
(614) 272-6791
Entity
Organization
Contact information
Practice address
2575 W BROAD ST, COLUMBUS, OH 43204-3333
(614) 272-6791
(614) 272-6826
Mailing address
2575 W BROAD ST, COLUMBUS, OH 43204-3333
(614) 272-6791
(614) 272-6826
Taxonomy
Speciality
Code
Description
License number
State
3336C0004X
Compounding Pharmacy
Primary
022325150
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
022325150
OHIO STATE BOARD OF PHARMACY LICENSE
OH
Enumeration date
07/24/2013
Last updated
07/24/2013
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