Organization
MYTILINI ENTERPRISES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES FANARAS (PRESIDENT)
(603) 224-9591
Entity
Organization
Contact information
Practice address
209 ROUTE 101, BEDFORD, NH 03110-5440
(603) 472-3919
(603) 472-7448
Mailing address
209 ROUTE 101, BEDFORD, NH 03110-5440
(603) 472-3919
(603) 472-7448
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
50
NH
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2166929
PK
—
05
—
80872998
—
NH
Enumeration date
09/07/2006
Last updated
04/25/2017
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