Provider Demographics
NPI:1598761637
Name:FANARIAN ENTERPRISES, LLC
Entity Type:Organization
Organization Name:FANARIAN ENTERPRISES, LLC
Other - Org Name:THE PRESCRIPTION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:WAKELIN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:603-224-9591
Mailing Address - Street 1:60 COMMERCIAL ST
Mailing Address - Street 2:STE 103
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-5096
Mailing Address - Country:US
Mailing Address - Phone:603-415-0100
Mailing Address - Fax:603-415-0104
Practice Address - Street 1:60 COMMERCIAL ST
Practice Address - Street 2:STE 103
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-5096
Practice Address - Country:US
Practice Address - Phone:603-415-0100
Practice Address - Fax:603-415-0104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-23
Last Update Date:2010-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0663P3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30703127Medicaid