Organization
BASCOM PHARMACY LLC
Active
Other names
BASCOM PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
CLIVE FULLER PHARMD (MANAGER)
(408) 995-6020
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
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
47147
CA
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2113723
PK
—
05
—
5993930001
—
CA
05
—
PHA471470
—
CA
Enumeration date
08/31/2006
Last updated
07/29/2025
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