Organization
RED BEAKER INC
Active
Other names
EDGEMONT PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE CHAMBERLAIN RPH (OWNER / RPH)
(801) 226-7994
Entity
Organization
Contact information
Practice address
3661 N CANYON RD, PROVO, UT 84604-4536
(801) 226-7994
(801) 226-2166
Mailing address
3661 N CANYON RD, PROVO, UT 84604-4536
(801) 226-7994
(801) 226-2166
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
45500841703
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2107781
PK
—
05
—
870349306009
—
UT
Enumeration date
07/04/2006
Last updated
07/19/2018
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