Healthcare Provider Details

I. General information

NPI: 1083869648
Provider Name (Legal Business Name): HAC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2008
Last Update Date: 05/11/2023
Certification Date: 05/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4129 SE 29TH ST
DEL CITY OK
73115-2643
US

IV. Provider business mailing address

PO BOX 25008
OKLAHOMA CITY OK
73125
US

V. Phone/Fax

Practice location:
  • Phone: 405-672-2180
  • Fax:
Mailing address:
  • Phone: 405-290-3423
  • Fax: 405-290-3523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number1-5352
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number1-5352
License Number StateOK

VIII. Authorized Official

Name: JOSH MILLER
Title or Position: DIRECTOR OF PHARMACY
Credential:
Phone: 405-290-3423