MEDICARE: NATHAN WILLIAM CAROTHERS JR.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	30432	TX

General Provider Information

NPI Number	:	1205437944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHAN WILLIAM CAROTHERS JR.

Provider Business Mailing Address
First Line	:	5750 COUNTY ROAD 614
Second Line	:
City	:	EARLY
State	:	TX
Zip	:	76802-3440
Country	:	US
Telephone Number	:	325-647-9221
Fax Number	:

Provider Business Practice Location Address
First Line	:	1503 W FRONT ST
Second Line	:
City	:	GOLDTHWAITE
State	:	TX
Zip	:	76844-2056
Country	:	US
Telephone Number	:	325-648-2484
Fax Number	:	855-899-4147

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2020
Last Update Date	:	10/13/2025

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