Licensee

Jigar N. Pokar Pharmacist License # 14246

Pharmacy License # 1154

Pharmacy Proprietor : Samson Management (2009) Ltd.

Address: PO BOX 539 Maskwacis AB T0C1N0

Proprietor Representative: Glenda Swampy Phone: 780-585-2468 ext:105

On request, the licensee will provide the name and practice permit number of any regulated member who provides a pharmacy service to the patient or who engages in the practice of pharmacy with respect to the patient.