1821113903 NPI number — HAC, INC.

Table of content: (NPI 1821113903)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821113903 NPI number — HAC, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAC, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HOMELAND PHARMACY #182
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821113903
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 25008
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73125
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-290-3423
Provider Business Mailing Address Fax Number:
405-290-3523

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1401 W BEECH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUNCAN
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73533-4234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-255-0228
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
JOSH
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF PHARMACY
Authorized Official Telephone Number:
405-290-3423

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  134638 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 134638 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100247720A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3712937 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".




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