| Name Of the Firm : | Maa Basanti Medical Store |
| Zone : | Southern Zone |
| Range : | Ganjam-III |
| Police Station : | |
| Address : | At/Po.: Mashabadi,via:Kullada,Plot No.1427,Kh.No.111 |
| RP Name : | Kala Krushna Padhy |
| Registration Number : | 8205 opc |
| Competent Person : | |
| Qualification : | D.Pharm |
| Name of the Proprietor : | Ratan Nandi |
| R : | 6197 |
| RC : | 6198 |
| RX : | 6199 |
| RR : | |
| RRC : | |
| W : | |
| WC : | |
| WX : | |
| Date of Issue : | 2011.09.26 |
| Date of Expiry : | 2016.09.25 |
| Remarks : |