Provider Demographics
NPI:1124065644
Name:HAC, INC.
Entity type:Organization
Organization Name:HAC, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
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:DPH
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 1:2501 S.E. WASHINGTON
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006
Practice Address - Country:US
Practice Address - Phone:918-335-2020
Practice Address - Fax:918-335-2021
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HAC, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-01
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
OK9-5246333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200114207NMedicaid
3718725OtherOTHER ID NUMBER-COMMERCIAL NUMBER
OK3718725OtherNCPDP