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General NPI Number Information
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NPI Number | 1821056078
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Entity Type | Organization
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Legal Business Name | PENGUIN MEDICAL SUPPLIES, INC
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Dates
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Enumeration Date | 05/03/2006
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Last Update Date | 07/29/2009
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Provider Practice Location Address
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Address Line | 6823 GREEN OAKS RD SUITE D
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City | FORT WORTH
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State | TX
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Zip | 76116-1732
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Country | US
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Telephone | 817-737-3637
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Fax | 817-737-3639
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Provider Business Mailing Address
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Address Line | 6823 GREEN OAKS RD SUITE D
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City | FORT WORTH
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State | TX
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Zip | 76116-1732
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Country | US
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Telephone | 817-737-3637
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Fax | 817-737-3639
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Authorized Official
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Title or Position | PHARMACIST OWNER
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Name | KALPESH PATEL
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Credential | RPH
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Telephone | 817-737-3637
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | 0088664
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License Number State | TX
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