Provider Demographics
NPI:1164469599
Name:HAC INC
Entity Type:Organization
Organization Name:HAC INC
Other - Org Name:N/A
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:HUNTER
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOGAN
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:405-290-3423
Mailing Address - Street 1:390 NE 36TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73105-2508
Mailing Address - Country:US
Mailing Address - Phone:405-290-3423
Mailing Address - Fax:405-290-3523
Practice Address - Street 1:5857 NW EXPRESSWAY
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73132-5240
Practice Address - Country:US
Practice Address - Phone:405-721-3351
Practice Address - Fax:405-773-2750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2010-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1-5194333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3718650OtherOTHER ID NUMBER-COMMERCIAL NUMBER
OK100247730JMedicaid
OK4969010037Medicare NSC