| Name Of the Firm : | Siva Medicine Shop |
| Zone : | Southern Zone |
| Range : | Ganjam II Range |
| Police Station : | |
| Address : | Plot No. 880/376, Khata No. 488/266, At: Surala Junction, P.O.- Girisola |
| RP Name : | Himanshu Sekhar Behera |
| Registration Number : | 11179 |
| Competent Person : | |
| Qualification : | D. Pharma |
| Name of the Proprietor : | Himanshu Sekhar Behera |
| R : | SLGAI-3959 |
| RC : | SLGAI-3960 |
| RX : | SLGAI-3961 |
| RR : | |
| RRC : | |
| W : | |
| WC : | |
| WX : | |
| Date of Issue : | |
| Date of Expiry : | |
| Remarks : |