NPIMap

Organization Active NPI

Church Square Pharmacy Inc.

  • Community/Retail Pharmacy
  • Cleveland, OH
National Provider Identifier
1376716464
Registry record updated May 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
021802000 Issued in OH
Legal business name
CHURCH SQUARE PHARMACY INC.
Practice address
1956 E 79TH St
Cleveland, OH 44103-4270
Phone
(216) 721-1772
Fax
(216) 721-1778
NPI assigned
Apr 9, 2008
Last updated
May 9, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 9, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Abdel Abukhalil
Title
Pharmacist
Phone
(216) 288-0557

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 021802000 OH Primary

Addresses

Primary practice location

1956 E 79TH St
Cleveland, OH 44103-4270

Mailing address

14529 Puritas Ave
Cleveland, OH 44135-2813
Phone (216) 721-1772

Other identifiers 1

IdentifierTypeStateIssuer
2824331MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930020971 OH DME Supplier - Pharmacy 2860682077 Practice locations: Cleveland, OH
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

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.

Laboratory certificates & supplier records

Derived by NPIMap

These 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

SupplierSuppliesMedicare assignment
Church Square Pharmacy Inc.1956 E 79TH St, Cleveland, OH 44103-4270(216) 721-1772 Epoetin|Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Non-Mail Order)|Canes and/or Crutches|Walkers|Orthoses: Off-The-Shelf|Nebulizer Equipment and/or Supplies Does not accept assignmentParticipating since Sep 30, 2009

National Provider Directory

National Provider Directory

Locations

7905 Euclid Ave
Cleveland, OH 44103
Phone (216) 721-1772

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1207699200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746748800000",
    "number": "1376716464",
    "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": "216-721-1772",
            "fax_number": "216-721-1778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1956 E 79TH ST",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441034270",
            "telephone_number": "216-721-1772",
            "fax_number": "216-721-1778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHURCH SQUARE PHARMACY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-09",
        "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": "PHARMACIST",
        "authorized_official_telephone_number": "216-288-0557",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "OH",
            "license": "021802000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2824331",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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.

Verify at the official NPI Registry.