MEDICARE: HAC 2, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336L0003X	Long Term Care Pharmacy	93013469	IL

General Provider Information

NPI Number	:	1003868928
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAC 2, INC

Provider Business Mailing Address
First Line	:	1053 JASON PL
Second Line	:
City	:	CHATHAM
State	:	IL
Zip	:	62629-2018
Country	:	US
Telephone Number	:	217-483-7431
Fax Number	:	217-483-7491

Provider Business Practice Location Address
First Line	:	1053 JASON PL
Second Line	:
City	:	CHATHAM
State	:	IL
Zip	:	62629-2018
Country	:	US
Telephone Number	:	217-483-7431
Fax Number	:	217-483-7491

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. DONNA G MATTERA
Credential	:	RPH
Telephone Number	:	217-622-3674

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	04/18/2012

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Directions to “HAC 2, INC ” Practice Location

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