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General NPI Number Information
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NPI Number | 1003868928
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Entity Type | Organization
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Legal Business Name | HAC 2, INC
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 04/18/2012
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Provider Practice Location Address
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Address Line | 1053 JASON PL
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City | CHATHAM
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State | IL
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Zip | 62629-2018
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Country | US
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Telephone | 217-483-7431
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Fax | 217-483-7491
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Provider Business Mailing Address
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Address Line | 1053 JASON PL
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City | CHATHAM
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State | IL
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Zip | 62629-2018
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Country | US
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Telephone | 217-483-7431
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Fax | 217-483-7491
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. DONNA G MATTERA
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Credential | RPH
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Telephone | 217-622-3674
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 93013469
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License Number State | IL
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