MEDICARE: HAC INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy
2	333600000X	Pharmacy	184628	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3718395	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1942325030
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAC INC

Provider Business Mailing Address
First Line	:	HOMELAND STORES INC
Second Line	:	PO BOX 25008
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73125-0008
Country	:	US
Telephone Number	:	405-216-2233
Fax Number	:	405-216-2283

Provider Business Practice Location Address
First Line	:	759 W GRAND AVE
Second Line	:
City	:	CHICKASHA
State	:	OK
Zip	:	73018-5742
Country	:	US
Telephone Number	:	405-224-5645
Fax Number	:	405-222-9252

Authorized Official
Title or Position	:	DIRECTOR OF PHAMARCY
Name	:	GERALD HINES
Credential	:
Telephone Number	:	405-216-2233

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	02/27/2008

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Directions to “HAC INC ” Practice Location

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