Provider Demographics
NPI:1659868461
Name:BELLE ISLE HEALTHCARE LLC
Entity Type:Organization
Organization Name:BELLE ISLE HEALTHCARE LLC
Other - Org Name:BELLE ISLE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:NOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:BSC PHARM
Authorized Official - Phone:469-424-0811
Mailing Address - Street 1:1105 CENTRAL EXPY N STE 2105
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-6103
Mailing Address - Country:US
Mailing Address - Phone:469-424-0811
Mailing Address - Fax:469-424-0814
Practice Address - Street 1:2117 CENTRAL DR STE 103
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-5883
Practice Address - Country:US
Practice Address - Phone:817-952-9947
Practice Address - Fax:817-952-9948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-17
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2177106OtherPK