Provider Demographics
NPI:1649395724
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 1:1200 GARY BLVD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601-2728
Practice Address - Country:US
Practice Address - Phone:580-323-0230
Practice Address - Fax:580-323-4944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK284630333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3713232OtherOTHER ID NUMBER-COMMERCIAL NUMBER
OK100247530AMedicaid
3713232OtherOTHER ID NUMBER-COMMERCIAL NUMBER