Healthcare Provider Details

I. General information

NPI: 1770504730
Provider Name (Legal Business Name): HAC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 05/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3734 PEAR ST
SAINT JOSEPH MO
64503-1507
US

IV. Provider business mailing address

PO BOX 25008
OKLAHOMA CITY OK
73125-0008
US

V. Phone/Fax

Practice location:
  • Phone: 816-236-2062
  • Fax: 816-232-2064
Mailing address:
  • Phone: 405-216-2233
  • Fax: 405-216-2283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number2005041200
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2005041200
License Number StateMO

VIII. Authorized Official

Name: GERALD HINES
Title or Position: DIRECTOR OF PHARMACY
Credential:
Phone: 405-216-2233