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Organization
PROVIDENCE HEALTH SYSTEM-SOUTHERN CALIFORNIA
Active
Organization
PROVIDENCE HEALTH SYSTEM-SOUTHERN CALIFORNIA
Active
Other names
PROVIDENCE LITTLE COMPANY OF MARY MEDICAL CENTER SAN PEDRO PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD W ANDERSON JR. (ASSISTANT SECRETARY ENROLLMENTS)
(425) 358-9786
Entity
Organization
Contact information
Practice address
1300 W 7TH ST, SAN PEDRO, CA 90732-3505
(310) 832-3311
(310) 514-5462
Mailing address
1300 W 7TH ST, SAN PEDRO, CA 90732-3505
(310) 514-5267
(310) 514-5462
Taxonomy
Speciality
Code
Description
License number
State
3336I0012X
Institutional Pharmacy
Primary
HSP47226
CA
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0544519
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
PHB472260
—
CA
Enumeration date
08/22/2006
Last updated
05/09/2025
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