Healthcare Provider Details

I. General information

NPI: 1568573848
Provider Name (Legal Business Name): ADIRONDACK APOTHECARY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4315 MAIN ST
PORT HENRY NY
12974-1339
US

IV. Provider business mailing address

PO BOX 458
SCHROON LAKE NY
12870-0458
US

V. Phone/Fax

Practice location:
  • Phone: 518-546-7244
  • Fax: 518-546-9722
Mailing address:
  • Phone: 518-532-7575
  • Fax: 518-532-9722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number027981
License Number StateNY

VIII. Authorized Official

Name: REBECCA DOYLE
Title or Position: VICE PRESIDENT
Credential: PHARMD
Phone: 518-532-0005