Bascom Pharmacy LLC

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

Legal business name

BASCOM PHARMACY LLC

Practice address

105 N Bascom Ave Ste 101
San Jose, CA 95128-1811

Phone

(408) 995-6020

Fax

(408) 995-5320

NPI assigned

Jul 29, 2025

Organization subpart

No

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

Authorized official

Name

Clive Fuller, PHARMDNPI 1669680997

Title

Manager

Phone

(510) 691-3371

Specialties & licenses 1

Addresses

Tax ID family

Bascom Pharmacy LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Bascom Pharmacy LLC

  • Community/Retail Pharmacy
  • San Jose, CA
  • NPI 1457463374
  NPD tax ID

Practitioners 1

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

• Clive Fuller, PHARMD

  • Pharmacist
  • San Jose, CA
  • NPI 1669680997
  NPD Authorized official

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

{
    "created_epoch": "1753747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753747200000",
    "number": "1205719978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 N BASCOM AVE STE 101",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951281811",
            "telephone_number": "408-995-6020",
            "fax_number": "408-995-5320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 N BASCOM AVE STE 101",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951281811",
            "telephone_number": "408-995-6020",
            "fax_number": "408-995-5320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BASCOM PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-07-29",
        "last_updated": "2025-07-29",
        "certification_date": "2025-07-29",
        "status": "A",
        "authorized_official_last_name": "FULLER",
        "authorized_official_first_name": "CLIVE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "510-691-3371",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patricia Victoria Bartz, M.S.OTR/L
• Antara Barua, M.D.
• Ido Baruch
• Kathleen Lyons Barzegar, R.N.
• Mae Jazmine Basa
• Bascom Pharmacy LLC
• Joseph Bascos
• Lee M Bashant, LCSW
• Erin Basile, IBCLC
• Bryan Basilio

• Long Term Care Pharmacy in San Jose, CA
• Providers in San Jose, CA by specialty
• Long Term Care Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2025; 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.