# HAC 4 LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** The Medicine Shoppe Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265897409
- **Authorized official:** NORMA HOLTZ (PHARMACY MANAGER)
- **Authorized official phone:** (309) 928-2491

## Contact information

- **Practice address:** 217 S MAIN ST, FARMER CITY, IL 61842-1455
- **Practice address phone:** (309) 928-2491
- **Practice address fax:** (309) 928-2493
- **Mailing address:** 217 S MAIN ST, FARMER CITY, IL 61842-1455
- **Mailing address phone:** (309) 928-2491
- **Mailing address fax:** (309) 928-2493

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 054019646 | IL | Yes |

## Other

- **Enumeration date:** 12/15/2015
- **Last updated:** 04/04/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2155868 | PK | — |