Provider Demographics
NPI:1457800088
Name:FAST, BEAUTY (R PH)
Entity type:Individual
Prefix:
First Name:BEAUTY
Middle Name:
Last Name:FAST
Suffix:
Gender:F
Credentials:R PH
Other - Prefix:MS
Other - First Name:BEAUTY
Other - Middle Name:
Other - Last Name:FAST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:R PH
Mailing Address - Street 1:3925 E GRANT RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2506
Mailing Address - Country:US
Mailing Address - Phone:520-327-9555
Mailing Address - Fax:520-327-9558
Practice Address - Street 1:3925 E GRANT RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2506
Practice Address - Country:US
Practice Address - Phone:520-327-9555
Practice Address - Fax:520-327-9558
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS022005183500000X
WI16204-40183500000X
TX524641835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care