{
"Npi": {
"NPI": "1376716464",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CHURCH SQUARE PHARMACY INC.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "14529 PURITAS AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CLEVELAND",
"MailingAddressStateName": "OH",
"MailingAddressPostalCode": "44135-2813",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "216-721-1772",
"MailingAddressFaxNumber": "216-721-1778",
"FirstLinePracticeLocationAddress": "1956 E 79TH ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CLEVELAND",
"PracticeLocationAddressStateName": "OH",
"PracticeLocationAddressPostalCode": "44103-4270",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "216-721-1772",
"PracticeLocationAddressFaxNumber": "216-721-1778",
"EnumerationDate": "04/09/2008",
"LastUpdateDate": "05/09/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ABUKHALIL",
"AuthorizedOfficialFirstName": "ABDEL",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PHARMACIST",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "216-288-0557",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "021802000",
"LicenseNumberStateCode": "OH",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}