Providence Health System-Southern California

Primary specialty

Institutional PharmacyTaxonomy code 3336I0012X

License

HSP47226 Issued in CA

Legal business name

PROVIDENCE HEALTH SYSTEM-SOUTHERN CALIFORNIA

Doing business as

Providence Little Company of Mary Medical Center San Pedro Pharmacy

Practice address

1300 W 7TH St
San Pedro, CA 90732-3505

Phone

(310) 832-3311

Fax

(310) 514-5462

NPI assigned

Aug 22, 2006

Last updated

May 9, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Donald W Anderson Jr.

Title

Assistant Secretary Enrollments

Phone

(425) 358-9786

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• PROVIDENCE LITTLE COMPANY OF MARY MEDICAL CENTER SAN PEDRO PHARMACY Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746748800000",
    "number": "1508972456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 W 7TH ST",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907323505",
            "telephone_number": "310-514-5267",
            "fax_number": "310-514-5462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 W 7TH ST",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907323505",
            "telephone_number": "310-832-3311",
            "fax_number": "310-514-5462"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH SYSTEM-SOUTHERN CALIFORNIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-22",
        "last_updated": "2025-05-09",
        "certification_date": "2025-05-09",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY ENROLLMENTS",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "3336I0012X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Institutional Pharmacy",
            "state": "CA",
            "license": "HSP47226",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PHB472260",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "0544519",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PROVIDENCE LITTLE COMPANY OF MARY MEDICAL CENTER SAN PEDRO PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Providence Health System - Southern California
• Providence Health System - Southern California (Providence Little Company of Mary Medical Center San Pedro OBHC)
• Providence Health System - Southern California (Providence Little Company of Mary Sub Acute Care Center)
• Providence Health System - Southern California (Providence Little Company of Mary Medical Center San Pedro)
• Providence Health System - Southern California (Providence Little Company of Mary Medical Center San Pedro)
• Providence Little Co. of Mary Hospital in San Pedro
• Sarah Katherine Pulvere, LCSW
• Quality in- Home Care LLC
• Nina Quan
• Quantum Blue Nursing, Apc

• Institutional Pharmacy in San Pedro, CA
• Providers in San Pedro, CA by specialty
• Institutional Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.