Provider Demographics
NPI:1699578690
Name:CLAREMEDICA VIKING LLC
Entity type:Organization
Organization Name:CLAREMEDICA VIKING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:L
Authorized Official - Last Name:MULLINIX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-758-3135
Mailing Address - Street 1:14750 NW 77TH CT STE 100
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1507
Mailing Address - Country:US
Mailing Address - Phone:786-758-3165
Mailing Address - Fax:
Practice Address - Street 1:4155 SW 130TH AVE STE 201
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3417
Practice Address - Country:US
Practice Address - Phone:305-455-3500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLAREMEDICA VIKING LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site