Provider Demographics
NPI:1710002811
Name:HAC INC
Entity Type:Organization
Organization Name:HAC INC
Other - Org Name:HOMELAND PHARMCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHAMARCY
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:HINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-216-2233
Mailing Address - Street 1:HOMELAND STORES INC
Mailing Address - Street 2:PO BOX 25008
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73125-0008
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1910 W 21ST ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-2105
Practice Address - Country:US
Practice Address - Phone:316-838-5908
Practice Address - Fax:316-838-7239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2097993336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1717769OtherOTHER ID NUMBER-COMMERCIAL NUMBER
1717769OtherOTHER ID NUMBER
4969010034Medicare NSC