Organization
PETRA PHARMACY CORP
Active
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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