| Name Of the Firm : | MAA SAMALESWARI MEDICAL STORE |
| Zone : | Western Zone, Sambalpur |
| Range : | Sambalpur |
| Police Station : | |
| Address : | AINTHAPALI, SAMBALPUR |
| RP Name : | PRATAP KU NAYAK |
| Registration Number : | 17848 |
| Competent Person : | |
| Qualification : | |
| Name of the Proprietor : | SRIKANTA KU PUROHIT |
| R : | 1156 |
| RC : | 1157 |
| RX : | 1158 |
| RR : | |
| RRC : | |
| W : | |
| WC : | |
| WX : | |
| Date of Issue : | 11/6/2002 |
| Date of Expiry : | 11/5/2017 |
| Remarks : |