| Name Of the Firm : | Balaji Medical Store |
| Zone : | Southern Zone |
| Range : | Ganjam II Range |
| Police Station : | |
| Address : | Plot No. 412/2682, 413/2683, Khata No. 1081/169, Tulu Road, At/P.O.- Kanishi Hata |
| RP Name : | Sabyasachi Gouda |
| Registration Number : | 17299 |
| Competent Person : | |
| Qualification : | D. Pharma |
| Name of the Proprietor : | Ajaya Mahanty |
| R : | SLGAI-1961 |
| RC : | SLGAI-1962 |
| RX : | SLGAI-1963 |
| RR : | |
| RRC : | |
| W : | |
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| WX : | |
| Date of Issue : | |
| Date of Expiry : | |
| Remarks : |