Healthcare Provider Details

I. General information

NPI: 1952218893
Provider Name (Legal Business Name): MAYA PEDERSEN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 JEFFERSON AVE SE
GRAND RAPIDS MI
49503-5218
US

IV. Provider business mailing address

13510 WALKING STICK LN
CHARDON OH
44024-9245
US

V. Phone/Fax

Practice location:
  • Phone: 616-685-5306
  • Fax:
Mailing address:
  • Phone: 440-941-9134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03446822
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302418900
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: