Provider Demographics
NPI:1801251129
Name:SKYY LABORATORY LLC
Entity type:Organization
Organization Name:SKYY LABORATORY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:
Authorized Official - First Name:COREY
Authorized Official - Middle Name:TYRONE
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-870-5956
Mailing Address - Street 1:7512 E INDEPENDENCE BLVD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-9412
Mailing Address - Country:US
Mailing Address - Phone:931-223-5466
Mailing Address - Fax:844-759-8329
Practice Address - Street 1:7512 E INDEPENDENCE BLVD
Practice Address - Street 2:SUITE 114
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227-9412
Practice Address - Country:US
Practice Address - Phone:931-223-5466
Practice Address - Fax:844-759-9329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC291U00000X
291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory