Healthcare Provider Details

I. General information

NPI: 1497271589
Provider Name (Legal Business Name): FASTPASS UCDFW, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2017
Last Update Date: 07/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2333 INTERNATIONAL PKWY SUITE NV202A
DFW AIRPORT TX
75261
US

IV. Provider business mailing address

5300 TOWN AND COUNTRY BLVD STE 260
FRISCO TX
75034-6913
US

V. Phone/Fax

Practice location:
  • Phone: 214-997-1950
  • Fax: 214-242-2008
Mailing address:
  • Phone: 469-208-5297
  • Fax: 214-260-0707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateTX

VIII. Authorized Official

Name: DR. CARRIE E DE MOOR
Title or Position: CEO
Credential: MD
Phone: 469-320-9820