=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659868461
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BELLE ISLE HEALTHCARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2018
-----------------------------------------------------
Last Update Date | 09/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2117 CENTRAL DR STE 103
-----------------------------------------------------
City | BEDFORD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76021-5883
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-952-9947
-----------------------------------------------------
Fax | 817-952-9948
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1105 CENTRAL EXPY N STE 2105
-----------------------------------------------------
City | ALLEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75013-6103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-424-0811
-----------------------------------------------------
Fax | 469-424-0814
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | SARA NOLAN
-----------------------------------------------------
Credential | BSC PHARM
-----------------------------------------------------
Telephone | 469-424-0811
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------