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NPI Code Detail

MEDICARE: RAEDAWN BALILO SICAT PHARM.D

MEDICARE: RAEDAWN BALILO SICAT PHARM.D
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacistPH60503967WA
2183500000XPharmacistRPH-0014415OR
3183500000XPharmacist18847NV

General Provider Information

NPI Number : 1609277680
Entity Type Code : Individual
Provider Name (Legal Business Name) : RAEDAWN BALILO SICAT PHARM.D
Provider Business Mailing Address
First Line : 1825 E WARM SPRINGS RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-4547
Country : US
Telephone Number : 702-361-6581
Fax Number :
Provider Business Practice Location Address
First Line : 1825 E WARM SPRINGS RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-4547
Country : US
Telephone Number : 702-361-6581
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/10/2014
Last Update Date : 01/22/2026

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