MEDICARE: MYTILINI 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	3336C0003X	Community/Retail Pharmacy	0746	NH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3061075	OTHER		OTHER ID NUMBER

General Provider Information

NPI Number	:	1679748719
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MYTILINI ENTERPRISES LLC

Provider Business Mailing Address
First Line	:	18 FOUNDRY ST
Second Line	:	SUITE 102
City	:	CONCORD
State	:	NH
Zip	:	03301-5419
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	18 FOUNDRY ST
Second Line	:	SUITE 102
City	:	CONCORD
State	:	NH
Zip	:	03301-5419
Country	:	US
Telephone Number	:	603-224-2111
Fax Number	:	603-225-4907

Authorized Official
Title or Position	:	OWNER
Name	:	CHARLIE FANARAS
Credential	:	RPH
Telephone Number	:	603-224-9591

Provider Enumeration Date	:	04/29/2008
Last Update Date	:	06/25/2008

Similar Medicare Providers

1346171675 — ALEGRIA HOME CARE NH LLC
Practice Location Address:

20 FOUNDRY ST FL 2
CONCORD, NH
03301-5419

Practice Phone: 516-605-5236
Practice Fax:

1154575710 — MRS. JENNA KRISTINA REARDON ARNP
Practice Location Address:

18 FOUNDRY ST , SUITE 201
CONCORD, NH
03301-5419

Practice Phone: 603-228-0071
Practice Fax:

1629366265 — MS. CAMELLA GRANARA FNP-BC, PMHNP-BC
Practice Location Address:

20 FOUNDRY ST , 2ND FLR
CONCORD, NH
03301-5419

Practice Phone: 617-500-5767
Practice Fax: 617-415-2708

1437407806 — BRYAN HAAK MS, LCMHC
Practice Location Address:

20 FOUNDRY ST FL 2
CONCORD, NH
03301-5419

Practice Phone: 603-371-2835
Practice Fax:

1679822043 — MRS. NADINE A FULLING FNP-BC, CLC
Practice Location Address:

20 FOUNDRY ST FL 2
CONCORD, NH
03301-5419

Practice Phone: 888-731-8994
Practice Fax:

1538551387 — STEPHANIE L. GREEN APRN-C
Practice Location Address:

20 FOUNDRY ST FL 2
CONCORD, NH
03301-5419

Practice Phone: 888-731-8994
Practice Fax:

Directions to “MYTILINI ENTERPRISES LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.