=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174667117
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADIRONDACK APOTHECARY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2007
-----------------------------------------------------
Last Update Date | 12/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3932 NYS ROUTE 22
-----------------------------------------------------
City | WILLSBORO
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12996-4507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-963-8946
-----------------------------------------------------
Fax | 518-963-7322
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 458
-----------------------------------------------------
City | SCHROON LAKE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12870-0458
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-532-7575
-----------------------------------------------------
Fax | 518-532-9722
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | REBECCA DOYLE
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 518-532-0005
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 028290
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------