Maple Leaf Compounding Pharmacy

Primary specialty

Compounding PharmacyTaxonomy code 3336C0004X

License

022325150 Issued in OH

Legal business name

MAPLE LEAF COMPOUNDING PHARMACY

Practice address

2575 W Broad St
Columbus, OH 43204-3333

Phone

(614) 272-6791

Fax

(614) 272-6826

NPI assigned

Jul 24, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Joseph Jerkins, PHARM.D

Title

Owner/Responsible Pharmacist

Phone

(614) 272-6791

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1374624000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1374624000000",
    "number": "1578905147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2575 W BROAD ST",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432043333",
            "telephone_number": "614-272-6791",
            "fax_number": "614-272-6826"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2575 W BROAD ST",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432043333",
            "telephone_number": "614-272-6791",
            "fax_number": "614-272-6826"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAPLE LEAF COMPOUNDING PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-24",
        "last_updated": "2013-07-24",
        "status": "A",
        "authorized_official_last_name": "JERKINS",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "OWNER/RESPONSIBLE PHARMACIST",
        "authorized_official_telephone_number": "614-272-6791",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PHARM.D"
    },
    "taxonomies": [
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "OH",
            "license": "022325150",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OHIO STATE BOARD OF PHARMACY LICENSE",
            "identifier": "022325150",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Compounding Pharmacy in Columbus, OH
• Providers in Columbus, OH by specialty
• Compounding Pharmacy in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.