| Name Of the Firm : | Prakash Medical Store |
| Zone : | Southern Zone |
| Range : | Ganjam I |
| Police Station : | |
| Address : | Plot No. 1051/3095,Khata No. 742/1200,Holding No. 18062,Ward,.No.23,Gosaninuagam,Berhampur |
| RP Name : | Sri Simadri Prasad Nayak |
| Registration Number : | 2485(OPC) |
| Competent Person : | |
| Qualification : | D.Pharma |
| Name of the Proprietor : | Sri Amiya Kumar Dalai |
| R : | GAI 6815 |
| RC : | GAI 6816 |
| RX : | GAI 6817 |
| RR : | |
| RRC : | |
| W : | |
| WC : | |
| WX : | |
| Date of Issue : | 11/22/2012 |
| Date of Expiry : | 11/21/2017 |
| Remarks : |