Organization
PETRA PHARMACY CORP
Active
Other names
Medicine Shoppe, ENOVA CARE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LINDA RABADI (CFO)
(951) 654-2791
Entity
Organization
Contact information
Practice address
1477 S SAN JACINTO AVE, SAN JACINTO, CA 92583-5105
(951) 927-5710
(951) 927-9834
Mailing address
1477 S SAN JACINTO AVE, SAN JACINTO, CA 92583-5105
(951) 927-5710
(951) 927-9834
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHY54602
CA
3336H0001X
Home Infusion Therapy Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0574271
NCPDP #
CA
01
—
1104901131
NPI
CA
05
—
PHA546020
—
CA
01
—
PHY54602
PHARMACY PERMIT
CA
Enumeration date
10/26/2006
Last updated
03/23/2026
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