| Name Of the Firm : | MAA MANGALA MEDICAL STORE |
| Zone : | Western Zone, Sambalpur |
| Range : | Sambalpur |
| Police Station : | |
| Address : | AT/PO-DHANUPALI, DIST-SAMBALPUR |
| RP Name : | JAYANTA KUMAR MOHANTY |
| Registration Number : | 16446 |
| Competent Person : | |
| Qualification : | |
| Name of the Proprietor : | AJIT KU PATTANAIK |
| R : | 1188 |
| RC : | 1189 |
| RX : | 1190 |
| RR : | |
| RRC : | |
| W : | |
| WC : | |
| WX : | |
| Date of Issue : | 4/3/2003 |
| Date of Expiry : | 4/2/2008 |
| Remarks : | ACR 03.04.2008 TO 02.04.2013 |