Provider Demographics
NPI:1689774986
Name:FOUNDER PROJECT RX, INC.
Entity Type:Organization
Organization Name:FOUNDER PROJECT RX, INC.
Other - Org Name:ENCORE PHARMACY #75
Other - Org Type:Doing Business As
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 1:10412 VISTA DEL SOL
Practice Address - Street 2:SUITE# 1A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925
Practice Address - Country:US
Practice Address - Phone:915-533-0167
Practice Address - Fax:915-533-0168
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOUNDER PROJECT RX, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-25
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336S0011X
TX238893336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX468692Medicaid
TX145520Medicaid
TX5337990019Medicare NSC