Petra Pharmacy Corp

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY54602 Issued in CA

Legal business name

PETRA PHARMACY CORP

Practice address

1477 S San Jacinto Ave
San Jacinto, CA 92583-5105

Phone

(951) 927-5710

Fax

(951) 927-9834

NPI assigned

Oct 26, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Linda Rabadi

Title

Cfo

Phone

(951) 654-2791

Specialties & licenses 3

Addresses

Other identifiers 4

Other names 2

• ENOVA CARE PHARMACY Doing business as
• Medicine Shoppe Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Vykhanh Tarr, PHARMD

  • Pharmacist
  • San Jacinto, CA
  • NPI 1649862160
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1774224000000",
    "number": "1104901131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1477 S SAN JACINTO AVE",
            "city": "SAN JACINTO",
            "state": "CA",
            "postal_code": "925835105",
            "telephone_number": "951-927-5710",
            "fax_number": "951-927-9834"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1477 S SAN JACINTO AVE",
            "city": "SAN JACINTO",
            "state": "CA",
            "postal_code": "925835105",
            "telephone_number": "951-927-5710",
            "fax_number": "951-927-9834"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETRA PHARMACY CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-26",
        "last_updated": "2026-03-23",
        "certification_date": "2026-03-23",
        "status": "A",
        "authorized_official_last_name": "RABADI",
        "authorized_official_first_name": "LINDA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "951-654-2791",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY54602",
            "primary": true
        },
        {
            "code": "3336H0001X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Home Infusion Therapy Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP #",
            "identifier": "0574271",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1104901131",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY PERMIT",
            "identifier": "PHY54602",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PHA546020",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ENOVA CARE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Medicine Shoppe",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lupe Livier Perez
• Mauricio Perez, PPS
• Sarah Ann Perez, MSW
• Lori Jo Permann
• Bruce Michael Peterson, DDS
• Phuong Pham-Martinez
• Erica Ashley Pickens
• Robert Edward Pierce, LPT
• Tracy Pipher
• Tamara Sue Pippin, FNP

• Community/Retail Pharmacy in San Jacinto, CA
• Providers in San Jacinto, CA by specialty
• Community/Retail Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.