| Name Of the Firm : | Ambica Medicine, |
| Zone : | Southern Zone |
| Range : | Ganjam I |
| Police Station : | |
| Address : | At: Plot No. 1172,Khata No. 1397, R.C.Das Lane, Kamapali Main Road, BAM |
| RP Name : | Sri Nirmal Chandra Dalai, |
| Registration Number : | 4542 (OPC) |
| Competent Person : | |
| Qualification : | D. Pharm |
| Name of the Proprietor : | Sri Dillip Kumar Bisoyi |
| R : | GAI-6456 |
| RC : | GAI-6457 |
| RX : | GAI-6458 |
| RR : | |
| RRC : | |
| W : | |
| WC : | |
| WX : | |
| Date of Issue : | 4/3/2012 |
| Date of Expiry : | 4/2/2017 |
| Remarks : |