Provider Demographics
NPI:1417741844
Name:CHEUNG, KAMOLCHANOK DEER (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KAMOLCHANOK
Middle Name:DEER
Last Name:CHEUNG
Suffix:
Gender:
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15912 WOODDALE DR
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:IL
Mailing Address - Zip Code:60180-9607
Mailing Address - Country:US
Mailing Address - Phone:331-425-3684
Mailing Address - Fax:
Practice Address - Street 1:1415 E STATE ST STE 800
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61104-2344
Practice Address - Country:US
Practice Address - Phone:779-696-9204
Practice Address - Fax:779-379-3774
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0513032393336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy