NPIMap

Organization Active NPI

Mytilini Enterprises, LLC

  • Community/Retail Pharmacy
  • Bedford, NH
National Provider Identifier
1174626550
Registry record updated Apr 25, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
50 Issued in NH
Legal business name
MYTILINI ENTERPRISES, LLC
Practice address
209 Route 101
Bedford, NH 03110-5440
Phone
(603) 472-3919
Fax
(603) 472-7448
NPI assigned
Sep 7, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Charles Fanaras
Title
President
Phone
(603) 224-9591

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 50 NH Primary
Compounding Pharmacy 3336C0004X

Addresses

Primary practice location

209 Route 101
Bedford, NH 03110-5440

Mailing address

209 Route 101
Bedford, NH 03110-5440
Phone (603) 472-3919

Other identifiers 2

IdentifierTypeStateIssuer
2166929OtherPK
80872998MedicaidNH

National Provider Directory

National Provider Directory
Tax ID family
Bedford Pharmacy Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1157587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493078400000",
    "number": "1174626550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "209 ROUTE 101",
            "city": "BEDFORD",
            "state": "NH",
            "postal_code": "031105440",
            "telephone_number": "603-472-3919",
            "fax_number": "603-472-7448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 ROUTE 101",
            "city": "BEDFORD",
            "state": "NH",
            "postal_code": "031105440",
            "telephone_number": "603-472-3919",
            "fax_number": "603-472-7448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYTILINI ENTERPRISES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-07",
        "last_updated": "2017-04-25",
        "status": "A",
        "authorized_official_last_name": "FANARAS",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "603-224-9591"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NH",
            "license": "50",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2166929",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "80872998",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bedford, NH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.