PETRA PHARMACY CORP NPI 1104901131

NPI Information

  • NPI: 1104901131
  • Provider Name: PETRA PHARMACY CORP
  • Classification: Pharmacy - 3336C0003X
  • Specialization: Community/Retail Pharmacy
  • Entity Type: Organization
  • Doing Business As: MEDICINE SHOPPE
  • CLIA Number: 05D2226650
  • Address: 1477 S SAN JACINTO AVE
    SAN JACINTO, CA
    ZIP 92583
  • Phone: (951) 927-5710

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NPI Details

PETRA PHARMACY CORP is a community/retail pharmacy pharmacy in San Jacinto, CA. The provider is a pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. PETRA PHARMACY CORP NPI is 1104901131. The provider is registered as an organization entity type.
The provider Is Doing Business As Medicine Shoppe.

The provider's business location address is:

1477 S SAN JACINTO AVE
SAN JACINTO, CA
ZIP 92583-105
Phone: (951) 927-5710
Fax: (951) 927-9834

The provider's authorized official is Linda Rabadi .
The authorized official title is Cfo and has the following contact phone number (951) 654-2791.

The CLIA number assigned to this NPI record is 05D2226650 - pharmacy with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/26/2006 and was last updated on 5/28/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
13336C0003XPharmacyCommunity/Retail PharmacyPHY54602CALIFORNIAYes
23336H0001XPharmacyHome Infusion Therapy PharmacyNo
33336L0003XPharmacyLong Term Care PharmacyNo

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
10574271OTHERCALIFORNIANCPDP #
21104901131OTHERCALIFORNIANPI
3PHY54602OTHERCALIFORNIAPHARMACY PERMIT
4PHA546020MEDICAIDCALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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