Provider Demographics
NPI:1821056078
Name:PENGUIN MEDICAL SUPPLIES, INC
Entity Type:Organization
Organization Name:PENGUIN MEDICAL SUPPLIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KALPESH
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:817-737-3637
Mailing Address - Street 1:6823 GREEN OAKS RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-1732
Mailing Address - Country:US
Mailing Address - Phone:817-737-3637
Mailing Address - Fax:817-737-3639
Practice Address - Street 1:6823 GREEN OAKS RD
Practice Address - Street 2:SUITE D
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-1732
Practice Address - Country:US
Practice Address - Phone:817-737-3637
Practice Address - Fax:817-737-3639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0088664332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1821056078OtherNPI
TX5678690001Medicare NSC