KAMOLCHANOK DEER CHEUNG, PharmD — NPI 1417741844 (Licensed & Credentialed Suppliers — Pharmacy, Specialty Pharmacy in ROCKFORD, IL)

CMS-1500 Box 24J / 33a • NPI

1417741844

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

3336S0011X (CMS 58)

Licensed & Credentialed Suppliers — Pharmacy, Specialty Pharmacy

Box 32 Service Location & ZIP+4

1415 E STATE ST STE 800, ROCKFORD, IL, 61104-2344

✓ 9-Digit EDI 837 ZIP+4 (61104-2344)

Practice Phone & Referral Fax

(779) 696-9204

Fax: (779) 379-3774

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1417741844 (KAMOLCHANOK DEER CHEUNG, PharmD) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1417741844` (NPI-1 Individual Practitioner)
Provider / Legal Name	KAMOLCHANOK DEER CHEUNG, PharmD
Plain-English Specialty	Licensed & Credentialed Suppliers — Pharmacy, Specialty Pharmacy NUCC Code: `3336S0011X` (Pharmacy, Specialty Pharmacy)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	1415 E STATE ST STE 800, ROCKFORD, IL, 61104-2344
Practice Telephone / Fax	Tel: (779) 696-9204 \| Fax: (779) 379-3774
Administrative Mailing Address	15912 WOODDALE DR, UNION, IL, 60180-9607
Enumeration & Last Sync	Enumerated: 2025-04-09 \| CMS Record Updated: 2025-04-09

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

1415 E STATE ST STE 800, ROCKFORD, IL, 61104-2344

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Plain-English Taxonomy & CMS Crosswalk (3336S0011X)

What Does Taxonomy Code 3336S0011X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 3336S0011X translates to:
"Licensed & Credentialed Suppliers — Pharmacy, Specialty Pharmacy"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 58 (Medical Supply Company with Pharmacist) • CMS Code A5 (Pharmacy)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Pharmacy, Specialty Pharmacy for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (KAMOLCHANOK DEER CHEUNG, PharmD)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`3336S0011X` — Pharmacy, Specialty Pharmacy Plain English: Licensed & Credentialed Suppliers — Pharmacy, Specialty Pharmacy	State: IL \| License: `051303239` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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KAMOLCHANOK DEER CHEUNG, PharmD (NPI #1417741844)