Provider Demographics
NPI:1629193719
Name:HAC, INC.
Entity Type:Organization
Organization Name:HAC, INC.
Other - Org Name:HOMELAND PHARMACY #195
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:JOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-290-3423
Mailing Address - Street 1:PO BOX 25008
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73125
Mailing Address - Country:US
Mailing Address - Phone:405-290-3423
Mailing Address - Fax:405-290-3523
Practice Address - Street 1:4301 S MAY AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73119-3275
Practice Address - Country:US
Practice Address - Phone:405-682-6191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK014640333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3713953OtherOTHER ID NUMBER-COMMERCIAL NUMBER
OK100247740AMedicaid
3713953OtherOTHER ID NUMBER-COMMERCIAL NUMBER