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General NPI Number Information
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NPI Number | 1104901131
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Entity Type | Organization
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Legal Business Name | PETRA PHARMACY CORP
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 05/28/2024
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Provider Practice Location Address
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Address Line | 1477 S SAN JACINTO AVE
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City | SAN JACINTO
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State | CA
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Zip | 92583-5105
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Country | US
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Telephone | 951-927-5710
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Fax | 951-927-9834
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Provider Business Mailing Address
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Address Line | 1477 S SAN JACINTO AVE
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City | SAN JACINTO
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State | CA
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Zip | 92583-5105
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Country | US
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Telephone | 951-927-5710
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Fax | 951-927-9834
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Authorized Official
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Title or Position | CFO
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Name | MS. LINDA RABADI
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Credential |
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Telephone | 951-654-2791
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336H0001X
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Taxonomy Name | Home Infusion Therapy Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY54602
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License Number State | CA
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