Healthcare Provider Details

I. General information

NPI: 1659377133
Provider Name (Legal Business Name): FANARAS ENTERPRISES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 08/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 N MAIN ST SUITE #1
CONCORD NH
03301-4921
US

IV. Provider business mailing address

125 N MAIN ST SUITE #1
CONCORD NH
03301-4921
US

V. Phone/Fax

Practice location:
  • Phone: 603-224-9591
  • Fax: 603-224-5361
Mailing address:
  • Phone: 603-224-9591
  • Fax: 603-224-5361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number0300
License Number StateNH

VIII. Authorized Official

Name: MR. CHARLES JOHN FANARAS
Title or Position: PRESIDENT
Credential: RPH
Phone: 603-224-9591