MEDICARE: MALCOLM ALBERT WEISS PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	10076	CO

General Provider Information

NPI Number	:	1639276645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALCOLM ALBERT WEISS PHARMD

Provider Business Mailing Address
First Line	:	18142 E BERRY DR
Second Line	:
City	:	CENTENNIAL
State	:	CO
Zip	:	80015-2618
Country	:	US
Telephone Number	:	303-690-9413
Fax Number	:

Provider Business Practice Location Address
First Line	:	4100 E MISSISSIPPI AVE
Second Line	:	SUITE 1110
City	:	GLENDALE
State	:	CO
Zip	:	80246-3048
Country	:	US
Telephone Number	:	303-504-2681
Fax Number	:	303-504-2697

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/08/2007

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