Provider Demographics
NPI:1063574952
Name:FOUNDER PROJECT RX, INC.
Entity type:Organization
Organization Name:FOUNDER PROJECT RX, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, MANAGING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:NICKY
Authorized Official - Middle Name:L
Authorized Official - Last Name:OTTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-239-6516
Mailing Address - Street 1:1620 W. NORTHWEST HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051
Mailing Address - Country:US
Mailing Address - Phone:817-572-0009
Mailing Address - Fax:817-572-0221
Practice Address - Street 1:4703 RICHMOND AVENUE
Practice Address - Street 2:SUITE#E
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027
Practice Address - Country:US
Practice Address - Phone:713-627-2370
Practice Address - Fax:713-627-3990
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOUNDER PROJECT RX, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-15
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX264053336S0011X, 3336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4523672OtherNCPDP
TX468693Medicaid
TX26405OtherTEXAS STATE BOARD OF PHARMACY LICENSE #
5337990016Medicare NSC