Healthcare Provider Details

I. General information

NPI: 1639276645
Provider Name (Legal Business Name): MALCOLM ALBERT WEISS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 E MISSISSIPPI AVE SUITE 1110
GLENDALE CO
80246-3048
US

IV. Provider business mailing address

18142 E BERRY DR
CENTENNIAL CO
80015-2618
US

V. Phone/Fax

Practice location:
  • Phone: 303-504-2681
  • Fax: 303-504-2697
Mailing address:
  • Phone: 303-690-9413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10076
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: