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
—
—
333600000X
Pharmacy
—
—
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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