# BASCOM PHARMACY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205719978
- **Authorized official:** CLIVE FULLER PHARMD (MANAGER)
- **Authorized official phone:** (510) 691-3371

## Contact information

- **Practice address:** 105 N BASCOM AVE STE 101, SAN JOSE, CA 95128-1811
- **Practice address phone:** (408) 995-6020
- **Practice address fax:** (408) 995-5320
- **Mailing address:** 105 N BASCOM AVE STE 101, SAN JOSE, CA 95128-1811
- **Mailing address phone:** (408) 995-6020
- **Mailing address fax:** (408) 995-5320

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 07/29/2025
- **Last updated:** 07/29/2025