=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518000926
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HAC 2 INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2007
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1053 JASON PL
-----------------------------------------------------
City | CHATHAM
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62629-2018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-483-7431
-----------------------------------------------------
Fax | 217-483-7491
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1053 JASON PL
-----------------------------------------------------
City | CHATHAM
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62629-2018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DONNA MATTERA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 217-622-9276
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 93013469
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------