Petra Pharmacy Corp
Petra Pharmacy Corp is a healthcare organization registered as Community/Retail Pharmacy in San Jacinto, CA, holding Type 2 (organization) NPI 1104901131 since 2006. The authorized official on file is Linda Rabadi, Cfo.
✓ Active NPI ✓ Valid NPI checksum
| NPI | 1104901131 |
|---|---|
| Entity type | Organization (Type 2) |
| Legal business name | Petra Pharmacy Corp |
| Other name | <Unavail> |
| Practice address | 1477 S SAN JACINTO AVE, San Jacinto, CA, 92583 |
| Phone | 9519275710 |
| Fax | 9519279834 |
| Enumeration date | 2006-10-26 |
| Last updated in NPPES | 2026-03-23 |
Authorized official
| Name | Linda Rabadi |
|---|---|
| Title | Cfo |
| Phone | 9516542791 |
Taxonomy & classification
| Taxonomy code | Specialty | Primary | License | State |
|---|---|---|---|---|
| 3336H0001X | Home Infusion Therapy Pharmacy | Secondary | — | — |
| 3336L0003X | Long Term Care Pharmacy | Secondary | — | — |
| 3336C0003X | Community/Retail Pharmacy | Primary | PHY54602 | CA |
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0574271 | Other | CA | NCPDP # |
| 1104901131 | Other | CA | NPI |
| PHY54602 | Other | CA | PHARMACY PERMIT |
| PHA546020 | Medicaid | CA | — |
Copy-ready billing details
Provider: Petra Pharmacy Corp NPI: 1104901131 Taxonomy: 3336C0003X (Community/Retail Pharmacy) Address: 1477 S SAN JACINTO AVE, San Jacinto, CA, 92583
Providers at this address
| NPI | Name | Type | Specialty | Location |
|---|---|---|---|---|
| 1649862160 | Vykhanh Tarr | Individual | Pharmacist | San Jacinto, CA |
Verify this record
Cross-check NPI 1104901131 against the authoritative CMS record: view Petra Pharmacy Corp on the official NPPES registry .
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes — even if the provider moves or changes specialty. Read the full guide or validate an NPI number.
Frequently asked questions
How current is this record?
Where is Petra Pharmacy Corp located?
Source: CMS NPPES (public data). Snapshot 2026-07-11. Provider record last updated 2026-03-23.