Organization
F D M EXCLUSIVE IMAGE INC
Active
Other names
COOVER PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
FARIBORZ MASSOUDI (OWNER)
(310) 833-2575
Entity
Organization
Contact information
Practice address
891 W 9TH ST, SAN PEDRO, CA 90731-3603
(310) 833-2575
(310) 832-2531
Mailing address
891 W 9TH STREET, SAN PEDRO, CA 90731
(310) 833-2575
(310) 832-2531
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY45471
CA
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2107535
PK
—
05
—
PHY45471
—
CA
Enumeration date
07/30/2006
Last updated
09/19/2025
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