Provider Demographics
NPI:1932135068
Name:FOUNDER PROJECT RX, INC.
Entity Type:Organization
Organization Name:FOUNDER PROJECT RX, INC.
Other - Org Name:F & M SPECIALTY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NICKY
Authorized Official - Middle Name:
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:817-720-1039
Practice Address - Street 1:117 LUCKNEY STATION RD
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-8402
Practice Address - Country:US
Practice Address - Phone:601-939-9353
Practice Address - Fax:601-939-6353
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOUNDER PROJECT RX, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-23
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336S0011X
MS05446/2.63336C0003X
MS054460263336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2159010OtherPK
2046351OtherPK
AL100360103Medicaid
AR162831716Medicaid
LA1269441Medicaid
MS0330681Medicaid
4470070001Medicare NSC