| Name Of the Firm : | BANSI MEDICAL STORE |
| Zone : | Western Zone, Sambalpur |
| Range : | Sambalpur |
| Police Station : | |
| Address : | SHERSUANTAL, PO- KUKUDAPALI, DIST- SAMBALPUR |
| RP Name : | NAGENDRA NARAYAN MOHANTA |
| Registration Number : | 11865 |
| Competent Person : | |
| Qualification : | |
| Name of the Proprietor : | BANSIDHAR PADHAN |
| R : | 1199 |
| RC : | 1200 |
| RX : | 1201 |
| RR : | |
| RRC : | |
| W : | |
| WC : | |
| WX : | |
| Date of Issue : | 5/21/2003 |
| Date of Expiry : | 5/20/2013 |
| Remarks : | ACR 21.05.2013 TO 20.05.2018 |