Provider Demographics
NPI:1609277680
Name:SICAT, RAEDAWN BALILO (PHARMD)
Entity Type:Individual
Prefix:
First Name:RAEDAWN
Middle Name:BALILO
Last Name:SICAT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7549 MYCROFT CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-8521
Mailing Address - Country:US
Mailing Address - Phone:702-249-1850
Mailing Address - Fax:
Practice Address - Street 1:1825 E WARM SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-4547
Practice Address - Country:US
Practice Address - Phone:702-361-6581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0014415183500000X
WAPH60503967183500000X
NV18847183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist