| Name Of the Firm : | Life Line Medical Store |
| Zone : | Southern Zone |
| Range : | Ganjam II Range |
| Police Station : | |
| Address : | Patta No. 171, Survey No. 192/784, At/P.O.- Mathasarsingi |
| RP Name : | Radhe Swam Swain |
| Registration Number : | 21699 |
| Competent Person : | |
| Qualification : | D. Pharma |
| Name of the Proprietor : | Rajib Lochan Mahapatra |
| R : | SLGAII-5709 |
| RC : | SLGAII-5710 |
| RX : | SLGAII-5711 |
| RR : | |
| RRC : | |
| W : | |
| WC : | |
| WX : | |
| Date of Issue : | |
| Date of Expiry : | |
| Remarks : |