Organization
MAPLE LEAF NEW ROME PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOSEPH JERKINS PHARM.D (OWNER)
(614) 272-6791
Entity
Organization
Contact information
Practice address
5212 W BROAD ST, COLUMBUS, OH 43228-1642
(614) 851-5811
(614) 851-5815
Mailing address
PO BOX 27005, COLUMBUS, OH 43227-0005
(614) 272-6791
(614) 272-6826
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
022295450
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
022295450
TERMINAL DISBRIBUTOR OF DANGEROUS DRUGS LICENSE
OH
Enumeration date
04/11/2013
Last updated
04/11/2013
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