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General NPI Number Information
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NPI Number | 1205719978
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Entity Type | Organization
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Legal Business Name | BASCOM PHARMACY LLC
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Dates
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Enumeration Date | 07/29/2025
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Last Update Date | 07/29/2025
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Provider Practice Location Address
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Address Line | 105 N BASCOM AVE STE 101
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City | SAN JOSE
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State | CA
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Zip | 95128-1811
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Country | US
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Telephone | 408-995-6020
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Fax | 408-995-5320
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Provider Business Mailing Address
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Address Line | 105 N BASCOM AVE STE 101
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City | SAN JOSE
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State | CA
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Zip | 95128-1811
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Country | US
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Telephone | 408-995-6020
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Fax | 408-995-5320
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Authorized Official
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Title or Position | MANAGER
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Name | CLIVE FULLER
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Credential | PHARMD
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Telephone | 510-691-3371
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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