Healthcare Provider Details

I. General information

NPI: 1427659937
Provider Name (Legal Business Name): ABEDALHAKEEM ABUKHALIL PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2020
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14529 PURITAS AVE
CLEVELAND OH
44135-2813
US

IV. Provider business mailing address

401 CLEVELAND ST
ELYRIA OH
44035-6143
US

V. Phone/Fax

Practice location:
  • Phone: 216-476-1400
  • Fax: 216-476-1401
Mailing address:
  • Phone: 440-309-4036
  • Fax: 440-309-4037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number03328847
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number03328847
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03328847
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: