| Name Of the Firm : | Maa Ambika Medical Store |
| Zone : | Central Zone |
| Range : | Bhadrak |
| Police Station : | |
| Address : | At / Po : Dhusuri, Dist: Bhadrak Plot No. 1497, Khata No.593/158 |
| RP Name : | Sri Binapani Tripathy |
| Registration Number : | 17070(O.P.C) |
| Competent Person : | -- |
| Qualification : | D.Pharm |
| Name of the Proprietor : | Sri Abhaya Kumar Sahoo |
| R : | BH-27973/R |
| RC : | BH-27974/RC |
| RX : | BH-10999/RX |
| RR : | -- |
| RRC : | -- |
| W : | -- |
| WC : | -- |
| WX : | -- |
| Date of Issue : | 12/13/2012 |
| Date of Expiry : | 12/12/2017 |
| Remarks : | Up to dated licence |