MEDICARE: FANARIAN ENTERPRISES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	0653	NH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2053779	OTHER		PK

General Provider Information

NPI Number	:	1639175110
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FANARIAN ENTERPRISES LLC

Provider Business Mailing Address
First Line	:	246 PLEASANT ST
Second Line	:	STE 100
City	:	CONCORD
State	:	NH
Zip	:	03301-2548
Country	:	US
Telephone Number	:	603-226-4848
Fax Number	:	603-228-7351

Provider Business Practice Location Address
First Line	:	246 PLEASANT ST STE 100
Second Line	:	STE 100
City	:	CONCORD
State	:	NH
Zip	:	03301-2548
Country	:	US
Telephone Number	:	603-226-4848
Fax Number	:	603-228-7351

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CHARLES FANARAS
Credential	:	BS
Telephone Number	:	603-224-9591

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	05/01/2017

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Directions to “FANARIAN ENTERPRISES LLC ” Practice Location

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