Provider Demographics
NPI:1164804001
Name:SICAM, EMMA BALOYO (RPH)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:BALOYO
Last Name:SICAM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10091 BONHAM CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-7605
Mailing Address - Country:US
Mailing Address - Phone:323-356-1217
Mailing Address - Fax:
Practice Address - Street 1:10091 BONHAM CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-7605
Practice Address - Country:US
Practice Address - Phone:323-356-1217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-28
Last Update Date:2015-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV16680183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist