Individual ProviderMica Inge KoliPharmacistPharmacy Service ProvidersPractice Address6055 Millwick Dr, Johns Creek, GA 30005-6743(678) 620-9356PECOS EnrollmentBased on the most recent information from CMS, provider Mica Inge Koli does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 4 days ago.Profile DetailsProvider ID1922551357Provider TypeIndividualFull NameKoli, Mica IngeTitleDr.CredentialR.PH. PHARMDGenderFemaleSole ProprietorYesEnumeration Date8/2/2016Last Updated8/2/2016Contact InformationPractice LocationPractice Address6055 Millwick Dr, Johns Creek, GA 30005-6743Phone(678) 620-9356FaxUnlisted FaxMailing LocationMailing Address6055 Millwick Dr, Johns Creek, GA 30005-6743Phone(678) 620-9356FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode183500000XPrimaryDescriptionPharmacistPharmacy Service ProvidersLicenseRPH016505GeorgiaProvider IdentifiersIDDescriptionIssuerIDRPH016505DescriptionOtherIssuerPHARMACISTGeorgiaID430715DescriptionOtherIssuerNABPGeorgia