# RED BEAKER INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** EDGEMONT PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659301885
- **Authorized official:** MIKE CHAMBERLAIN RPH (OWNER / RPH)
- **Authorized official phone:** (801) 226-7994

## Contact information

- **Practice address:** 3661 N CANYON RD, PROVO, UT 84604-4536
- **Practice address phone:** (801) 226-7994
- **Practice address fax:** (801) 226-2166
- **Mailing address:** 3661 N CANYON RD, PROVO, UT 84604-4536
- **Mailing address phone:** (801) 226-7994
- **Mailing address fax:** (801) 226-2166

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 45500841703 | UT | Yes |

## Other

- **Enumeration date:** 07/04/2006
- **Last updated:** 07/19/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2107781 | PK | — |
| 05 | — | 870349306009 | — | UT |