| Name Of the Firm : | Samual Medical Store |
| Zone : | South Zone |
| Range : | Nuapada |
| Police Station : | |
| Address : | Plot No- 198, Khata No- 198, At/po- khariar |
| RP Name : | P. Santosh Kumar Patro |
| Registration Number : | 10688 |
| Competent Person : | |
| Qualification : | D.Pharma |
| Name of the Proprietor : | Robert Poul Dani |
| R : | SL-NU-1227R |
| RC : | SL-NU-1228Rc |
| RX : | |
| RR : | |
| RRC : | |
| W : | |
| WC : | |
| WX : | |
| Date of Issue : | 8/12/2011 |
| Date of Expiry : | 8/11/2016 |
| Remarks : |