| Name Of the Firm : | Mamta Medicine Store |
| Zone : | Central |
| Range : | Puri |
| Police Station : | |
| Address : | Plot No- 1633, Kh. No- 709, At/PO- Siriapur, Po- Pipili,Dist-Puri |
| RP Name : | Sri Prabhanjan Mahapatra |
| Registration Number : | 23189/OPC |
| Competent Person : | - |
| Qualification : | D.pharma |
| Name of the Proprietor : | Mrs Mamta Ali |
| R : | 25220 |
| RC : | 25221 |
| RX : | 9669 |
| RR : | |
| RRC : | |
| W : | |
| WC : | |
| WX : | |
| Date of Issue : | 3/17/2010 |
| Date of Expiry : | 3/16/2015 |
| Remarks : |