Jimson Bacolod
Individual provider Active NPI Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist · Carson, CA
NPI 1609152297 · NPPES record last updated Jul 27, 2026
Key facts
- NPI
- 1609152297
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist 1835P0018X
- License
- 56767 (CA)
- Practice address
- 141 W Carson St
Carson, CA 90745-2602 - Phone
- (424) 280-3022
- Fax
- (424) 264-5607
- NPI assigned
- Oct 26, 2011
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Vistamed Corp | Current |
Accepting new patients |
Locations
141 W Carson St
Carson, CA 90745
Phone (424) 280-3022
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | 1835P0018X | 56767 | CA | Yes |
| Pharmacist | 183500000X | 56767 | CA |
Addresses
Primary practice location
141 W Carson St
Carson, CA 90745-2602
Mailing address
141 W Carson St
Carson, CA 90745-2602
Phone (424) 280-3022
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- Annette A Azcarate
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- Badii Lee Dental Corporation, Inc.
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- Nancy M Bahem
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All providers in Carson, CA · Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 27, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.