Provider Demographics
NPI:1477592855
Name:H.A.C., INC.
Entity Type:Organization
Organization Name:H.A.C., INC.
Other - Org Name:HOMELAND PAHRMACY #468
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:TALITHA
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:D PH
Authorized Official - Phone:405-290-3423
Mailing Address - Street 1:390 N.E. 36TH ST.
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73105
Mailing Address - Country:US
Mailing Address - Phone:405-290-3421
Mailing Address - Fax:405-290-3521
Practice Address - Street 1:2005 N. 14TH ST., STE, 110
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601
Practice Address - Country:US
Practice Address - Phone:580-762-7444
Practice Address - Fax:580-762-5110
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:H.A.C., INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-04
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6-5247333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK3720732OtherNCPDP
3720732OtherOTHER ID NUMBER-COMMERCIAL NUMBER
OK20011427OPMedicaid