Bascom Pharmacy

LBN: Bascom Pharmacy Llc
Bascom Pharmacy is an health care organization with primary practice located at 105 N Bascom Ave Ste 101, San Jose CA 95128-1811. The organization recently has 3 registered licenses in different health care specialties including Suppliers / Pharmacy, Suppliers / Community/Retail Pharmacy, Suppliers / Specialty Pharmacy. Suppliers / Community/Retail Pharmacy is the primary health care specialty. Bascom Pharmacy Llc can be contacted via phone (408) 995-6020, or through Fuller, Clive via phone (408) 995-6020.

Contact Information

Primary practice address
105 N Bascom Ave Ste 101 San Jose CA 95128-1811
Phone: (408) 995-6020
Fax: (408) 995-5320
Website:
Map and Directions
Authorized official contact:
Name: Fuller, Clive PHARMD
Phone: (408) 995-6020

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Pharmacy 333600000X
Suppliers / Community/Retail Pharmacy 3336C0003X 47147 California
Suppliers / Specialty Pharmacy 3336S0011X

Profile Details

NPI number 1457463374
LBN Legal business name Bascom Pharmacy Llc
DBA Doing business as Bascom Pharmacy
Authorized official Fuller, Clive PHARMD
Entity Organization
Organization subpart 1 No
Enumeration date Aug 31st, 2006
Last updated Apr 11th, 2017 - about 7 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1457463374 NPPES
California MEDICAID PHA471470
California Other 2113723
California MEDICAID 5993930001

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