Provider Demographics
NPI:1871114181
Name:GILL, TARAH BROOKE
Entity type:Individual
Prefix:DR
First Name:TARAH
Middle Name:BROOKE
Last Name:GILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TARAH
Other - Middle Name:BROOKE
Other - Last Name:ARRINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9237 W 136TH ST
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-2126
Mailing Address - Country:US
Mailing Address - Phone:210-792-9904
Mailing Address - Fax:
Practice Address - Street 1:4001 LAKE BREEZE AVE STE 100
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55429-3860
Practice Address - Country:US
Practice Address - Phone:952-847-0279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-28
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN124533183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist