Provider Demographics
NPI:1225206329
Name:LOUJIL INC
Entity Type:Organization
Organization Name:LOUJIL INC
Other - Org Name:BLACKSTONE HEALTH MART PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PIC
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:KISHFY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:401-475-5655
Mailing Address - Street 1:465 LONSDALE AVE
Mailing Address - Street 2:STE B
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-1874
Mailing Address - Country:US
Mailing Address - Phone:401-475-5655
Mailing Address - Fax:401-475-2631
Practice Address - Street 1:465 LONSDALE AVE
Practice Address - Street 2:STE B
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-1874
Practice Address - Country:US
Practice Address - Phone:401-475-5655
Practice Address - Fax:401-475-2631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
RIPHA004383336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4107048OtherNCPDP PROVIDER IDENTIFICATION NUMBER
RILI 69635Medicaid