Healthcare Provider Details

I. General information

NPI: 1992820088
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: 05/11/2023
Certification Date: 05/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 W 3RD ST
ELK CITY OK
73644-5202
US

IV. Provider business mailing address

PO BOX 25008
OKLAHOMA CITY OK
73125
US

V. Phone/Fax

Practice location:
  • Phone: 580-225-7961
  • Fax:
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 Number354635
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

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