Healthcare Provider Details

I. General information

NPI: 1437274529
Provider Name (Legal Business Name): HAC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 02/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19302 EAST ADMIRAL BLVD
CATOOSA OK
74015
US

IV. Provider business mailing address

HOMELAND STORES INC PO BOX 25008
OKLAHOMA CITY OK
73125-0008
US

V. Phone/Fax

Practice location:
  • Phone: 918-266-2543
  • Fax: 918-266-7453
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 Number384648
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

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