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Organization
CHURCH SQUARE PHARMACY INC.
Active
Organization
CHURCH SQUARE PHARMACY INC.
Active
Other names
Clark LowCost Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
ABDEL ABUKHALIL (PRESIDENT)
(216) 288-0557
Entity
Organization
Contact information
Practice address
3107 CLARK AVE, CLEVELAND, OH 44109-1145
(216) 651-8685
(216) 651-8766
Mailing address
14529 PURITAS AVE, CLEVELAND, OH 44135-2813
(216) 651-8685
(216) 651-8766
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
022004150
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2122864
PK
—
05
—
3013358
—
OH
Enumeration date
12/02/2009
Last updated
05/09/2025
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