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PETRA PHARMACY CORP
NPI 1104901131
Pharmacy - Community/Retail Pharmacy in San Jacinto, CA

Active since October 26, 2006CLIA 05D2226650 · Waiver
1477 S SAN JACINTO AVE, SAN JACINTO, CA 92583(951) 927-5710(951) 927-9834 Get Directions Write a Review

NPPES record last updated: March 23, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Mar 23, 2026, Jun 23, 2023, Mar 7, 2023 and 2 more (5 updates tracked since 2016).

About Petra Pharmacy Corp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PETRA PHARMACY CORP (NPI 1104901131), doing business as Enova Care Pharmacy, is a healthcare organization registered as a community/retail pharmacy in San Jacinto, California and active in the NPI registry since October 2006. The organization holds a CLIA Waiver certificate valid through June 1, 2027 and lists Linda Rabadi, Cfo, as its authorized official.

NPPES Registry Identity

NPI1104901131
Entity TypeOrganization
Primary Taxonomy3336C0003X
Legal Business NamePETRA PHARMACY CORP
Location Address1477 S SAN JACINTO AVESan Jacinto, CA 92583-5105
Mailing Address1477 S San Jacinto AveSan Jacinto, CA 92583-5105 · (951) 927-5710 · Fax (951) 927-9834
Phone(951) 927-5710
Fax(951) 927-9834
Organization SubpartNo
Authorized OfficialLinda RabadiCfo · (951) 654-2791
Enumeration DateOctober 26, 2006
Last NPPES UpdateMarch 23, 20265 updates tracked since enumeration
NPPES CertifiedMarch 23, 2026
✔ NPI 1104901131 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyPharmacy · Community/Retail PharmacySuppliers
Taxonomy Code3336C0003X
License✔ Licensed in CA · PHY54602
Definition
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.
Also ListedPharmacy · Home Infusion Therapy PharmacyTaxonomy 3336H0001X
Also ListedPharmacy · Long Term Care PharmacyTaxonomy 3336L0003X
1477 S SAN JACINTO AVE, San Jacinto, CA 92583
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Other Names 2

Doing Business AsEnova Care Pharmacy
Doing Business AsMedicine Shoppe

Other Identifiers 4

Other0574271CA · Ncpdp #
Other1104901131CA · Npi
OtherPHY54602CA · Pharmacy Permit
MedicaidPHA546020CA

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Alliant Health Plans, Inc., Ambetter from Absolute Total Care, Ambetter from Arizona Complete Health and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D2226650

Petra Pharmacy Corp Dba Medicine Shoppe, The · San Jacinto, CA
Active · expires Jun 1, 2027
CLIA Number05D2226650
Laboratory TypePharmacy
Certificate Effective DateJune 2, 2025
Certificate Expiration DateJune 1, 2027
Laboratory DirectorVick Tarr
Laboratory Phone(951) 654-2791
Laboratory LocationPetra Pharmacy Corp Dba Medicine Shoppe, The1477 South San Jacinto Ave, San Jacinto, CA 92583
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

VYKHANH TARR PHARMD
Pharmacist
1477 S SAN JACINTO AVE
SAN JACINTO, CA 92583
Riverside County (951) 654-2791

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Petra Pharmacy Corp's NPI number?

The NPI number for Petra Pharmacy Corp is 1104901131. It was assigned to this organization in the NPPES registry on October 26, 2006. The provider is doing business as Enova Care Pharmacy and Medicine Shoppe.

Where is Petra Pharmacy Corp located?

Petra Pharmacy Corp is located at 1477 S San Jacinto Ave, San Jacinto, CA 92583. The listed phone number is (951) 927-5710.

What is Petra Pharmacy Corp's specialty?

The primary specialty registered for this NPI is Pharmacy, specializing in Community/Retail Pharmacy, with taxonomy code 3336C0003X.

Does Petra Pharmacy Corp hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D2226650) is associated with this NPI, valid through June 1, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Petra Pharmacy Corp accept?

Health plans from Alliant Health Plans, Inc., Ambetter Health, Ambetter Health of Delaware, Ambetter from Absolute Total Care and Ambetter from Arizona Complete Health and 48 other insurers list Petra Pharmacy Corp as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Petra Pharmacy Corp was last updated on March 23, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.