Organization
LOUJIL INC
Active
Other names
BLACKSTONE HEALTH MART PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
GARY KISHFY RPH (PRESIDENT/PIC)
(401) 475-5655
Entity
Organization
Contact information
Practice address
465 LONSDALE AVE, STE B, PAWTUCKET, RI 02860-1874
(401) 475-5655
(401) 475-2631
Mailing address
465 LONSDALE AVE, STE B, PAWTUCKET, RI 02860-1874
(401) 475-5655
(401) 475-2631
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHA00438
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4107048
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
LI 69635
—
RI
Enumeration date
02/12/2008
Last updated
08/23/2011
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