Healthcare Provider Details

I. General information

NPI: 1386261683
Provider Name (Legal Business Name): MAYA HARDMAN PHC, PHARMD, BC-ADM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2020
Last Update Date: 11/30/2025
Certification Date: 11/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 ALTO ST
SANTA FE NM
87501-2406
US

IV. Provider business mailing address

1035 ALTO ST
SANTA FE NM
87501-2406
US

V. Phone/Fax

Practice location:
  • Phone: 505-982-4425
  • Fax: 505-982-1263
Mailing address:
  • Phone: 505-982-4425
  • Fax: 505-982-1263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03439619
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00009287
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPC00000327
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: