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General NPI Number Information
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NPI Number | 1659377133
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Entity Type | Organization
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Legal Business Name | FANARAS ENTERPRISES, INC
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Dates
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Enumeration Date | 06/21/2005
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Last Update Date | 08/19/2014
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Provider Practice Location Address
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Address Line | 125 N MAIN ST SUITE #1
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City | CONCORD
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State | NH
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Zip | 03301-4921
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Country | US
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Telephone | 603-224-9591
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Fax | 603-224-5361
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Provider Business Mailing Address
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Address Line | 125 N MAIN ST SUITE #1
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City | CONCORD
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State | NH
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Zip | 03301-4921
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Country | US
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Telephone | 603-224-9591
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Fax | 603-224-5361
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. CHARLES JOHN FANARAS
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Credential | RPH
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Telephone | 603-224-9591
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 0300
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License Number State | NH
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