Pacific Medical Center Pharmacy Canyon Park – Clinic Pharmacy, NPI 1720301203
Clinic Pharmacy
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Pacific Medical Center Pharmacy Canyon Park
416 S TYLER ST
AMARILLO, TX 791012346
Phone: (806) 242-7782
Fax: (206) 531-2394
Type: Mailing
800, South Polk Street, Amarillo, Potter County, Texas, 79101, United States
AMARILLO, TX 791011429
Phone: (806) 324-5400
Fax: (206) 531-2394
Type: Mailing
214th Street Southeast, Thrashers Corner, Bothell, Snohomish County, Washington, 98012-7134, United States
BOTHELL, WA 980214418
Phone: (425) 412-6335
Fax: (206) 531-2394
Type: Location
320 S POLK ST STE 200
AMARILLO, TX 791011436
Phone: (806) 242-7782
Fax: (206) 531-2394
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2024-05-13
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20240513001038 | O | Pharmacy | WA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 79101)
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