Provider Demographics
NPI:1639175110
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:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:FANARAS
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:603-224-9591
Mailing Address - Street 1:246 PLEASANT ST
Mailing Address - Street 2:STE 100
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-2548
Mailing Address - Country:US
Mailing Address - Phone:603-226-4848
Mailing Address - Fax:603-228-7351
Practice Address - Street 1:246 PLEASANT ST STE 100
Practice Address - Street 2:STE 100
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-2548
Practice Address - Country:US
Practice Address - Phone:603-226-4848
Practice Address - Fax:603-228-7351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NH06533336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30702650Medicaid
2053779OtherPK
5206290001Medicare NSC