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General NPI Number Information
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NPI Number | 1376716464
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Entity Type | Organization
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Legal Business Name | CHURCH SQUARE PHARMACY INC.
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Dates
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Enumeration Date | 04/09/2008
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Last Update Date | 05/09/2025
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Provider Practice Location Address
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Address Line | 1956 E 79TH ST
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City | CLEVELAND
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State | OH
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Zip | 44103-4270
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Country | US
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Telephone | 216-721-1772
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Fax | 216-721-1778
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Provider Business Mailing Address
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Address Line | 14529 PURITAS AVE
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City | CLEVELAND
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State | OH
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Zip | 44135-2813
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Country | US
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Telephone | 216-721-1772
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Fax | 216-721-1778
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Authorized Official
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Title or Position | PHARMACIST
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Name | MR. ABDEL ABUKHALIL
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Credential |
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Telephone | 216-288-0557
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 021802000
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License Number State | OH
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