Active NPI
Church Square Pharmacy Inc.
- Community/Retail Pharmacy
- Cleveland, OH
National Provider Identifier
1326376310
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 022004150
- Legal business name
- CHURCH SQUARE PHARMACY INC.
- Doing business as
- Clark LowCost Pharmacy
- Practice address
- 3107 Clark Ave
Cleveland, OH 44109-1145 - Phone
- (216) 651-8685
- Fax
- (216) 651-8766
- NPI assigned
- Dec 2, 2009
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Abdel Abukhalil
- Title
- President
- Phone
- (216) 288-0557
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 022004150 | OH | Primary |
Addresses
Primary practice location
3107 Clark Ave
Cleveland, OH 44109-1145
Mailing address
14529 Puritas Ave
Cleveland, OH 44135-2813
Phone (216) 651-8685
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3013358 | Medicaid | OH | |
| 2122864 | Other | PK |
Other names 1
- Clark LowCost Pharmacy
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20140328001904 | OH | Part B Supplier - Mass Immunization (Roster Biller Only) | 2860682077 |
3 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Cleveland, OH |
| O20140514000190 | OH | DME Supplier - Pharmacy | 2860682077 | Practice locations: Cleveland, OH |
Other NPIs with the same Medicare PAC ID 2
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
Other NPIs on the same Medicare enrollment 3
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Community/Retail Pharmacy
- Cleveland, OH
- NPI 1467738732
O20140328001904
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Clark Lowcost Pharmacy | Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order)|Canes and/or Crutches|Walkers|Orthoses: Off-The-Shelf|Nebulizer Equipment and/or Supplies | Does not accept assignment |
National Provider Directory
National Provider Directory- Tax ID family
- Church Square Pharmacy Inc
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
- Community/Retail Pharmacy
- Garfield Heights, OH
- NPI 1669020186
-
- Community/Retail Pharmacy
- Cleveland, OH
- NPI 1053727545
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1259712000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1746748800000",
"number": "1326376310",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14529 PURITAS AVE",
"city": "CLEVELAND",
"state": "OH",
"postal_code": "441352813",
"telephone_number": "216-651-8685",
"fax_number": "216-651-8766"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3107 CLARK AVE",
"city": "CLEVELAND",
"state": "OH",
"postal_code": "441091145",
"telephone_number": "216-651-8685",
"fax_number": "216-651-8766"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CHURCH SQUARE PHARMACY INC.",
"organizational_subpart": "NO",
"enumeration_date": "2009-12-02",
"last_updated": "2025-05-09",
"certification_date": "2025-05-09",
"status": "A",
"authorized_official_last_name": "ABUKHALIL",
"authorized_official_first_name": "ABDEL",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "216-288-0557"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": null,
"license": null,
"primary": false
},
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": null,
"license": null,
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "OH",
"license": "022004150",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3013358",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2122864",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Clark LowCost Pharmacy",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Cleveland, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.