# PROVIDENCE HEALTH SYSTEM-SOUTHERN CALIFORNIA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** PROVIDENCE LITTLE COMPANY OF MARY MEDICAL CENTER SAN PEDRO PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1508972456
- **Authorized official:** DONALD W ANDERSON JR. (ASSISTANT SECRETARY ENROLLMENTS)
- **Authorized official phone:** (425) 358-9786

## Contact information

- **Practice address:** 1300 W 7TH ST, SAN PEDRO, CA 90732-3505
- **Practice address phone:** (310) 832-3311
- **Practice address fax:** (310) 514-5462
- **Mailing address:** 1300 W 7TH ST, SAN PEDRO, CA 90732-3505
- **Mailing address phone:** (310) 514-5267
- **Mailing address fax:** (310) 514-5462

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336I0012X | Institutional Pharmacy | HSP47226 | CA | Yes |
| 3336L0003X | Long Term Care Pharmacy | — | — | — |

## Other

- **Enumeration date:** 08/22/2006
- **Last updated:** 05/09/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0544519 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |
| 05 | — | PHB472260 | — | CA |