| Name Of the Firm : | Nazareth Medical Store |
| Zone : | S/Z |
| Range : | PKD |
| Police Station : | |
| Address : | At/Po- Gillakuta, Antaraba, P.No.195/248, K.N.31/5 |
| RP Name : | Sri Bodasingi Sraban Kumar, Regd No.- 26125/Opc |
| Registration Number : | Sri Bodasingi Sraban Kumar, Regd. No. 26125/OPC |
| Competent Person : | |
| Qualification : | |
| Name of the Proprietor : | Sri Johan Majhi |
| R : | 7819 |
| RC : | 7820 |
| RX : | 7821 |
| RR : | |
| RRC : | |
| W : | |
| WC : | |
| WX : | |
| Date of Issue : | 7/19/2014 |
| Date of Expiry : | 7/18/2019 |
| Remarks : |