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General NPI Number Information
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NPI Number | 1205437944
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Entity Type | Individual
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Provider Name | NATHAN WILLIAM CAROTHERS JR.
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Gender | Male
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Dates
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Enumeration Date | 11/06/2020
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Last Update Date | 10/13/2025
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Provider Practice Location Address
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Address Line | 1503 W FRONT ST
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City | GOLDTHWAITE
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State | TX
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Zip | 76844-2056
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Country | US
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Telephone | 325-648-2484
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Fax | 855-899-4147
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Provider Business Mailing Address
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Address Line | 5750 COUNTY ROAD 614
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City | EARLY
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State | TX
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Zip | 76802-3440
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Country | US
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Telephone | 325-647-9221
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 30432
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License Number State | TX
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