Medicine Shoppe
LBN: Petra Pharmacy Corp
Medicine Shoppe is an health care organization with primary practice located at 1477 S San Jacinto Ave , San Jacinto CA 92583-5105. The organization recently has 3 registered licenses in different health care specialties including Suppliers / Community/Retail Pharmacy, Suppliers / Home Infusion Therapy Pharmacy, Suppliers / Long Term Care Pharmacy. Suppliers / Community/Retail Pharmacy is the primary health care specialty.
Petra Pharmacy Corp can be contacted via phone (951) 927-5710, or through Rabadi, Linda via phone (951) 654-2791.
Contact Information
Primary practice address
1477 S San Jacinto Ave
San Jacinto CA 92583-5105
Phone: (951) 927-5710
Fax: (951) 927-9834
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Suppliers / Community/Retail Pharmacy | 3336C0003X | PHY54602 | California |
| Suppliers / Home Infusion Therapy Pharmacy | 3336H0001X | ||
| Suppliers / Long Term Care Pharmacy | 3336L0003X |
Profile Details
| NPI number | 1104901131 |
|---|---|
| LBN Legal business name | Petra Pharmacy Corp |
| DBA Doing business as | Medicine Shoppe |
| Authorized official | Rabadi, Linda |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Oct 26th, 2006 |
| Last updated | May 28th, 2024 - about 7 months ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1104901131 | NPPES |
| California | Other | 0574271 | NCPDP # |
| California | Other | 1104901131 | NCPDP # |
| California | Other | PHY54602 | NCPDP # |
| California | MEDICAID | PHA546020 | NCPDP # |
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