Healthcare Provider Details

I. General information

NPI: 1649395724
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: 01/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 GARY BLVD
CLINTON OK
73601-2728
US

IV. Provider business mailing address

390 NE 36TH ST
OKLAHOMA CITY OK
73105-2508
US

V. Phone/Fax

Practice location:
  • Phone: 580-323-0230
  • Fax: 580-323-4944
Mailing address:
  • Phone: 405-290-3423
  • Fax: 405-290-3523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number284630
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: HUNTER J HOGAN III
Title or Position: DIRECTOR OF PHARMACY
Credential:
Phone: 405-290-3423