Bascom Pharmacy LLC
Bascom Pharmacy LLC is a healthcare organization registered as Community/Retail Pharmacy in San Jose, CA, holding Type 2 (organization) NPI 1457463374 since 2006. The authorized official on file is Clive Fuller, Manager.
✓ Active NPI ✓ Valid NPI checksum
| NPI | 1457463374 |
|---|---|
| Entity type | Organization (Type 2) |
| Legal business name | Bascom Pharmacy LLC |
| Other name | <Unavail> |
| Practice address | 105 N BASCOM AVE, STE 101, San Jose, CA, 95128 |
| Phone | 4089956020 |
| Fax | 4089955320 |
| Enumeration date | 2006-08-31 |
| Last updated in NPPES | 2025-07-29 |
Authorized official
| Name | Clive Fuller |
|---|---|
| Title | Manager |
| Phone | 4089956020 |
Taxonomy & classification
| Taxonomy code | Specialty | Primary | License | State |
|---|---|---|---|---|
| 3336S0011X | Specialty Pharmacy | Secondary | — | — |
| 333600000X | Pharmacy | Secondary | — | — |
| 3336C0003X | Community/Retail Pharmacy | Primary | 47147 | CA |
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PHA471470 | Medicaid | CA | — |
| 2113723 | Other | — | PK |
| 5993930001 | Medicaid | CA | — |
Copy-ready billing details
Provider: Bascom Pharmacy LLC NPI: 1457463374 Taxonomy: 3336C0003X (Community/Retail Pharmacy) Address: 105 N BASCOM AVE, STE 101, San Jose, CA, 95128
Providers at this address
| NPI | Name | Type | Specialty | Location |
|---|---|---|---|---|
| 1003859661 | Alexander Doan | Individual | Nephrology Physician | San Jose, CA |
| 1376588160 | Arash Padidar | Individual | Vascular & Interventional Radiology Physician | San Jose, CA |
| 1669486700 | Paul Cipriano | Individual | Vascular & Interventional Radiology Physician | San Jose, CA |
| 1679582589 | Smriti Nalwa | Individual | Obstetrics & Gynecology Physician | San Jose, CA |
| 1326145673 | Visakha Goonewardena | Individual | Internal Medicine Physician | San Jose, CA |
| 1891865192 | Sung-Eun Lim | Individual | Prosthodontics | San Jose, CA |
| 1578621074 | Mohammad Shenasa | Individual | Interventional Cardiology Physician | San Jose, CA |
| 1942368444 | Hossein Shenasa | Individual | Interventional Cardiology Physician | San Jose, CA |
Verify this record
Cross-check NPI 1457463374 against the authoritative CMS record: view Bascom Pharmacy LLC on the official NPPES registry .
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes — even if the provider moves or changes specialty. Read the full guide or validate an NPI number.
Frequently asked questions
Where is Bascom Pharmacy LLC located?
How current is this record?
Source: CMS NPPES (public data). Snapshot 2026-07-10. Provider record last updated 2025-07-29.