| Name Of the Firm : | Siba Ram Medical Store |
| Zone : | Southern Zone |
| Range : | Ganjam II Range |
| Police Station : | |
| Address : | Plot No. 947, Khata No. 509, At: Kushapur, P.O.- Baghala |
| RP Name : | Dilip Kumar Nahak |
| Registration Number : | 22179 |
| Competent Person : | |
| Qualification : | D. Pharma |
| Name of the Proprietor : | Puspa Sri Nahak |
| R : | SLGAII-5269 |
| RC : | SLGAII-5270 |
| RX : | SLGAII-5271 |
| RR : | |
| RRC : | |
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| WC : | |
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| Date of Issue : | |
| Date of Expiry : | |
| Remarks : |