Healthcare Provider Details

I. General information

NPI: 1689695645
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

903 N 36TH ST
SAINT JOSEPH MO
64506-2971
US

IV. Provider business mailing address

PO BOX 25008
OKLAHOMA CITY OK
73125-0008
US

V. Phone/Fax

Practice location:
  • Phone: 816-236-2002
  • Fax: 816-236-2004
Mailing address:
  • Phone: 405-216-2233
  • Fax: 405-216-2283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number2005041385
License Number StateMO

VIII. Authorized Official

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