Organization
BASCOM PHARMACY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CLIVE FULLER PHARMD (MANAGER)
(510) 691-3371
Entity
Organization
Contact information
Practice address
105 N BASCOM AVE STE 101, SAN JOSE, CA 95128-1811
(408) 995-6020
(408) 995-5320
Mailing address
105 N BASCOM AVE STE 101, SAN JOSE, CA 95128-1811
(408) 995-6020
(408) 995-5320
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
—
—
Other
Enumeration date
07/29/2025
Last updated
07/29/2025
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