Provider Demographics
NPI:1841564523
Name:HAC, INC.
Entity Type:Organization
Organization Name:HAC, INC.
Other - Org Name:HOMELAND PHARMACY #616
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:K
Authorized Official - Last Name:PESSEL
Authorized Official - Suffix:
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:405-290-3421
Mailing Address - Fax:405-290-3521
Practice Address - Street 1:3330 NW 56TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4479
Practice Address - Country:US
Practice Address - Phone:405-917-9860
Practice Address - Fax:405-917-9823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-28
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1-5858332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100247730SVMedicaid
OK4969010049Medicare NSC