Sarana PBF 06-02-2016

<body>
<h3>DAFTAR SARANA PEDAGANG BESAR FARMASI (PBF) <br />

PROVINSI JAWA TIMUR</h3>
<table border="1" bgcolor="#fff" widtd="100%">
<tr>
<th class="head1">NO</th>
<th class="head1">NAMA KAB/KOTA</th>
<th class="head1">NO ID PBF</th>
<th class="head1">NAMA PBF</th>
<th class="head1">STATUS (Pusat/Cabang)</th>
<th class="head1">NO IZIN</th>
<th class="head1">ALAMAT</th>
<th class="head1">TELP</th>
<th class="head1">PENANGGUNG JAWAB</th>
<th class="head1">JENIS KELAMIN (P/L)</th>
<th class="head1">IZIN PENANGGUNG JAWAB</th>
<th class="head1">JENIS SARANA DISTRIBUSI</t
h>
<th class="head1">NAMA PIMPINAN</th>
<th class="head1">STATUS OPERATIONAL</th>
<th class="head1">PELAPORAN</th>
<th class="head1">KETERANGAN</th>
<th class="head1">TUTUP</th>
<th class="head1">TAHUN</th>
</tr>
<tr>
<td>1</td>
<td>KAB. BANGKALAN</td>
<td></td>
<td>PT. LEMBU SURO</td>
<td>Pusat</td>
<td>630/Menkes/SK/IV/2005 25 April 2005</td>
<td>Jl. Nangka Raya 11 Kamal Bangkalan</td>
<td></td>
<td>Ani Ultralindaningtyas</td>
<td>P</td>
<td>39796/Pend/AA</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>2</td>
<td>KAB. BANYUWANGI</td>
<td></td>
<td>ANDHI CIPTA JAYA UTAMA PT</td>
<td>Cabang</td>
<td>35175/PBF/VIII/01 13 Agustus 2001</td>
<td>Jl. Brawijaya 12 A Banyuwangi</td>
<td></td>
<td>Nuning Elissa Furoidah</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>3</td>
<td></td>
<td>ANDIKA INTISURYA KUSUMA FARMA PT</td>
<td></td>
<td></td>
<td>Dsn. Krajan RT.01.RW.V Sukonatar Kec.Sro
no, Banyuwangi</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>4</td>
<td></td>
<td>SUMBER GONDO PERKASA PT</td>
<td>Pusat</td>
<td>377/Menkes/SK/III/2004 19 Maret 2004</td
>
<td>Jl. Raya Jember Stail 87 Genteng Banyuwa
ngi</td>
<td></td>
<td>Yeni Sintia Dewi 0501.896AA</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>5</td>
<td>KAB. BOJONEGORO</td>
<td></td>
<td>KAPAS MAKMUR SENTOSA PT</td>
<td></td>
<td></td>
<td>Jl. Raya Kapas 53 Bojonegoro</td>

<td></td>
<td>Juliati</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>6</td>
<td>KAB. BONDOWOSO</td>
<td></td>
<td>MAWAR ABADI PHARMINDO PT</td>
<td>Pusat</td>
<td>HK.07.01/I/346/10 4-11-2010</td>
<td>Jl. Letjen Suprapto 81 Bondowoso</td>
<td>0332-427727</td>
<td>Melisa, SFarm,Apt</td>
<td>P</td>
<td> KP.01.03.1.3.4044</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>7</td>
<td></td>
<td>MITRA ABADI PHARMINDO PT</td>
<td>Pusat</td>
<td>1487/Menkes/SK/X/2003</td>
<td>Perum Taman Sari Indah Blok J-8 & J.9 Bo
ndowoso</td>
<td></td>
<td>Siti Rumaikah 02/SIK.AA/IV/2006</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>8</td>
<td></td>
<td>TEGUH KARYA RAHARDJO PT</td>
<td>Cabang</td>
<td>35192/PBF/IV/2002 15 April 2002</td>
<td>Jl. A. Yani 8 ? 10 Bondowoso </td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
esik
<td>9</td>
<td>KAB. GRESIK</td>
<td></td>
<td>BINTANG PRAMESTI UTAMA PT</td>
<td>Pusat</td>
<td>HK.07.01/I/464/09 18-9-2009</td>
<td>Kantor :Jl. Kalimantan 48 Kav 51 GKB Gr
Gudang:Jl. Kutilang V no.18 GKA Gresik </td>
<td>031-70958236</td>
<td>Solikha </td>
<td>P</td>
<td>SIK 446/949/437.52/2009</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>10</td>
<td></td>
<td>RAJAWALI NUSINDO CAB GRESIK PT </td>
<td>Cabang</td>
<td>P2T/6/03.11/V/2010 20 mei 2010</td>
<td>Jl. Usman Sadar 36 Gresik</td>
<td>031-3977164/ 71019466</td>
<td>Agsutina Eka Puspitasari, SFarm,Apt </td
>
<td>P</td>
<td>KP.01.03.1.3.0120 </td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>11</td>
<td>KAB. JEMBER</td>
<td></td>
<td>ANTAR MITRA SEMBADA CAB JEMBER PT</td>
<td>Cabang</td>
<td>P2T/13/03.11/VII/2010 7 Juli 2010</td>
<td>Jl. Nusantara III Blok C 25 Kaliwates Je
mber, (alamat baru)</td>
<td> 0331-4281-081804517170</td>
<td>Sri Wahyuni </td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>12</td>
<td></td>
<td>ANUGRAH ARGON MEDICA PT</td>
<td>Cabang</td>
<td>071/16003/PBF.Cab/13.32P1/VIII/2005</td>
<td>Jl. Nusantara H-23 Kaliwates Jember
</td>
<td> Telp. 0331 ? 481819</td>
<td>Dewi Kanthi Lestari
na Sukma Lestari </td>

<td>P</td>
<td> 41987/Pend/AA
0502.1789.AA</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>13</td>
<td></td>
<td>ANUGRAH PHARMINDO LESTARI CAB JEMBER PT<
/td>
<td>Cabang</td>
<td>31028/PBF/Cab-27/IX/01</td>
<td>Jl. Brawijaya 4 Jember</td>
<td></td>
<td>Ratna B </td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>14</td>
<td></td>
<td>BINA SAN PRIMA CAB JEMBER PT</td>
<td>Cabang</td>
<td>442/9864/101.5/2010</td>
<td>Jl. Letjen Sutoyo 138 Komplek pergudanga
n H Moedjib
Jember </td>
<td> 0331-332928</td>
<td>Umi Hanik, SFarm,Apt</td>
<td>P</td>
<td> KP.01.03.1.3.5331</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>15</td>
<td></td>
<td>BORSUMIJ WEHRY INDONESIA PT (BINA WAHANA
INDONESIA PT)</td>
<td></td>
<td></td>
<td>Jl. PB. Sudirman Jember</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>16</td>
<td>KAB. JOMBANG</td>
<td></td>
<td>CIPTA PRAKARSA JAYA PT</td>
<td>Pusat</td>
<td>YF.05.DJ.I.PBF.477 14 Juli 2006</td>

<td>Selatan Pabrik Gula No.91 Cukir? Diwek,
Jombang</td>
<td></td>
<td>Sri Ambarwati </td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>17</td>
<td></td>
<td>SAKAJAJA MAKMUR ABADI CAB JOMBANG</td>
<td>Cabang</td>
<td>021.35062/PBF/13.12/XII/2003</td>
<td>Jl. Yos Sudarso 48 D Denanyar Jombang</t
d>
<td></td>
<td>Dhina Agung Saputra </td>
<td>p</td>
<td>0502.2778/AA</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>18</td>
<td>KAB. KEDIRI</td>
<td></td>
<td>DOS NI ROHA PT CABANG KEDIRI</td>
<td>Cabang</td>
<td>22.496.2/PBF.Cab/13.21/ II/2007</td>
<td>Jl. Mayor Bismo No. 229 Kediri </td>
<td></td>
<td>Elisabeth Molyna </td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>19</td>
<td></td>
<td>SUPRA USADHATAMA CAB KEDIRI PT</td>
<td>Cabang</td>
<td>P2T/42/03.11/X/2010</td>
<td>Jl. Mataram 176 Kab Kediri</td>
<td>0354-673670,673671</td>
<td>Hendra Tri Pramono, SFarm,Apt</td>
<td>L</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>20</td>
<td></td>
<td>TEMPO CAB KEDIRI</td>
<td>Cabang</td>
<td>P2T/21/03.11/VII/2010</td>
<td>Jl. Mataram 176 Kab Kediri</td>
<td>0354-681350</td>
<td>Dina Mariani, SFarm, Apt </td>
<td>P</td>
<td>KP. 01.03.1.3.3748</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>21</td>
<td>KAB. PAMEKASAN</td>
<td>35-471</td>
<td>MEGA KARYA IND. JAYA PT</td>
<td>Pusat</td>
<td>442/1987/111.5/2007
7 Mei 2007</td
>
<td>Nyalabu Indah Blok D No. 1 Pamekasan
</td>
<td>(0324 ) 7700074</td>
<td>Novi Hidayati </td>
<td>P</td>
<td>44319/ Pend /AA</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>22</td>
<td>KAB. PONOROGO</td>
<td>35-469</td>
<td>MENTARI INDAH PERMAI PT</td>
<td>Cabang</td>
<td>35153/PBF/XI/00</td>
<td>Jl. Janoko 53 Ponorogo</td>
<td>(0352) 481356</td>
<td>Umi Mar?atul Sholichah</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>23</td>
<td>KAB. SIDOARJO</td>
<td></td>
<td>ABIRAWA SETIA SEJAHTERA PT</td>
<td>Pusat</td>
<td>966/Menkes/SK/VII/2004</td>
<td>Jl. Delta Sari Indah AX-14 Sidoarjo</td>
<td>031-7098811, 8554730</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>24</td>
<td></td>
<td>ALAMANDA MEDICA FARMA PT</td>
<td>Pusat</td>
<td>651/Menkes/SK/V/2003 12 Mei 2003</td>
<td>Jl. Jatisari Permai I/D4 Wisma Permai Bu
ngurasih Waru Sidoarjo</td>
<td>Hayuatul Choriyah</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>25</td>
<td></td>
<td>ANDHIKA MITRA SERASI PT</td>
<td>Cabang</td>
<td>31361/PBF/Cab-1/XII/993</td>
<td>Ruko Pondok ChandraJl. Palem I TC-15 Si
doarjo</td>
<td></td>
<td>Kariyati</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>26</td>
<td></td>
<td>ANUGERAH PHARMINDO LESTARI PT 031-843983
9</td>
<td>Cabang</td>
<td>442/7874/101.5/2010</td>
<td>Jl. Brebek Industri I / 1 A Waru Sidoarj
o </td>
<td> (031) 8482335 ( Baru )</td>
<td>Iweng Adrilaksani </td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>27</td>
<td></td>
<td>BANGKIT HUSADA FARMA PT</td>
<td>Pusat</td>
<td>403/Menkes/SK/III/2005 17 Maret 2005</t
d>
<td>Jl. Delta Sari Indah BE-17 Sidoarjo</td>
<td>031-8538377</td>
<td>Yuni Siswati</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>28</td>
<td></td>
<td>BINA MITRA JAYA BERSAMA PT</td>
<td>Pusat</td>
<td>YF.05.DJ.I.PBF.495.2
31 Mei 2007</td>
<td>Jl. Ruko Getway A 36-37 Sidoarjo</td>
<td></td>
<td>Eko Purwanto</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>29</td>
<td></td>
<td>BORSUMIJ WEHRY INDONESIA PT (BINA WAHANA
INDONESIA PT)</td>
<td></td>
<td></td>
<td>Jl. Raya Waru 44 Waru Sidoarjo</td>
<td></td>
<td>Teguh Wardoyo</td>
<td>L</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>30</td>
<td></td>
<td>BORWITA CITRA PRIMA PT</td>
<td>Pusat</td>
<td>843/Menkes/SK/VIII/2004</td>
<td>Jl. Raya Taman 48 A Taman
Sidoarjo</t
d>
<td></td>
<td>Shirley Regina P</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>31</td>
<td></td>
<td>BUWANA NUGROHO LESTARI PT</td>
<td></td>
<td></td>
<td>Jl. Perum Magersari Permai Blok J-12 Sid
oarjo</td>
<td>031-8942267</td>
<td>Bahrul Supyan Ali S</td>
<td>L</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>32</td>
<td></td>
<td>CITRA MANDIRI FARMATAMA PT</td>
<td>Cabang</td>
<td>16035/PBF/Cab-I/I/01 12 Januari 2001</td
>
<td>Jl. Jeruk VI/5 Sidoarjo</td>
<td></td>
<td>Djamilah</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>33</td>
<td></td>
<td>DAYA MUDA AGUNG PT</td>
<td>Cabang</td>
<td>P2T/12/03.11/VII/ 2010 5 Juli 2010</td
>
<td>Jl. Nangka 265 Desa Sruni Gedangan Sid
oarjo</td>
<td>031-8549320</td>
<td>Nita Purnamawati, S.Farm, Apt</td>
<td>P</td>
<td> KP.01.03.1.3.2574</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>34</td>
<td></td>
<td>DELTA INTAN MANDIRI PT</td>
<td>Pusat</td>
<td>YF.05.DJ.I.PBF.294 5 Juni 2006</td>
<td>Jl. Taman Puspa Anggaswangi C.I/12 A Si
doarjo</td>
<td></td>
<td>Yayuk Indra Triana</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>35</td>
<td></td>
<td>DEMPO SENTOSA PT</td>
<td>Cabang</td>
<td>067.12015/PBF.Cab/13.10/VII/2005</td>
<td>Komp.Gudang West Gate B-19 Gedangan Si
doarjo</td>
<td></td>
<td>Arief Panji S</td>
<td>L</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>36</td>
<td></td>
<td>DUA SEKAWAN SEJAHTERA PT</td>
<td></td>
<td></td>
<td>Jl. Pondok Jati II Blok A.28 Sidoarjo</t
d>
<td>031-8964631</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>37</td>
<td></td>
<td>ENSEVAL PUTRA MEGA-TRADING (RDC) PT</td>
<td></td>
<td></td>
<td>Jl. Berbek Industri VII no.8-10 Sidoar
jo</td>
<td>031-8411007</td>
<td>Ike Lydia Suryani, S.Farm, Apt</td>
<td>P</td>
<td> KP.01.03.1.3.2759</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>38</td>
<td></td>
<td>ENSEVAL PUTRA MEGA-TRADING CAB. SIDOARJO
PT</td>
<td>Cabang</td>
<td></td>
<td>Jl. Berbek Industri VII no.8-10
Sidoar
jo</td>
<td>031-8411007</td>
<td>Sisilia Pitoyo, S.Farm, Apt
<td>P</td>
<td> KP.01.03.1.3.5430</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
</td>
<tr>
<td>39</td>
<td></td>
<td>FITALAB UTAMA KARYA PT CAB. SIDOARJO</td
>
<td>Cabang</td>
<td>076.1196/PBF/Cab-I/13.01/XII/2005</td>
<td>Jl. A Yani 41-43 Komp.Pergudangan Centra
l Square Blok E.5 Gedangan Sidoarjo</td>
<td></td>
<td>Lely Astuti Imam</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>40</td>
<td></td>
<td>FORTA MITRA SEJATI PT</td>
<td>Cabang</td>
<td>003.29.78/PBF/Cab-I/13.01/I/2007 </td>
<td>Jl. Raya Wisma Tropodo AC-8 Sidoarjo</
td>
<td></td>
<td>Sari Murti Dewi A</td>
<td>P</td>
<td>442/III.5/5023B/2003</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>41</td>
<td></td>
<td>GATRA PERSADA PT</td>
<td>Cabang</td>
<td>35136/PBF/III/98
8 Maret 2000</
td>
<td>Jl. Sambisari Kav Utara Blok F No.06 RT.
35 RW 6 Taman Sidoarjo</td>
<td>031-8667542</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>42</td>
<td></td>
<td>INDOSITRA UTAMA PT</td>
<td>Pusat</td>
<td>877/Menkes/SK/VIII/ 2004</td>
<td>Jl. Taman Pondok Jati Blok AY-6 Sidoarjo
</td>
<td>031-7883577</td>
<td>Estining Wuriandayani</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>43</td>
<td></td>
<td>INSAN INDOFARMA PT</td>
<td>Cabang</td>
<td>35107/PBF/III/98</td>
<td>Jl. Brigjen Katamso IV/203 Waru Sidoarjo
</td>
<td></td>
<td>Fitri Diyah Rachmawati</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>44</td>
<td></td>
<td>KANIGORO INDAH PERKASA PT </td>
<td>Cabang</td>
<td>35107/PBF/III/98</td>
<td>Pertokoan Taman Jenggala Mas Blok B-15Jl
. Sunandar Priyo Sudarmo Sidoarjo</td>
<td></td>
<td>Soestyowati</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>45</td>
<td></td>
<td>KIMIA FARMA TRAD & DISTRIB CABANG SIDOAR
JO PT</td>
<td>Cabang</td>
<td>P2T/38/03.11/X/ 2010 18 okt 2010</td>
<td>Jl. Nangka Pergudangan Tanrise South Gat
e C no. 9 Seruni Gedangan Sidoarjo</td>
<td>031-8910502</td>
<td>Rudi Syahrial, S.Farm, Apt</td>
<td>L</td>
<td>KP.01.03.1.3.3636</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>46</td>
<td></td>
<td>LELELA BHAKTI UTAMA PT</td>
<td>Pusat</td>
<td>YF.05.DJ.I.PBF.379 27 Juni 2006</td>
<td>Ruko Deltasari Indah AN/08 Sidoarjo</td>
<td></td>
<td>Siti Wafiroh</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>47</td>
<td></td>
<td>MARGA NUSANTARA JAYA PT</td>
<td>Cabang</td>
<td>31024/PBF/Cab-6/V/02 3 Mei 2002</td>
<td>Jl. Berbek Industri III no.17 Waru
S
idoarjo</td>
<td></td>
<td>Adis Sugiastuti</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>48</td>
<td></td>
<td>MAXINDO HEALTH PERKASA PT</td>
<td></td>
<td></td>
<td>Jl. Raya Sedati Agung 27 Sidoarjo</td>
<td></td>
<td>Inge Lianawati</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>49</td>
<td></td>
<td>MEDINAROSA KARYA YASA PT</td>
<td>Pusat</td>
<td>397/Menkes/SK/III/ 2005 16 Maret 2005</
td>
<td>Jl. Nakula E-12 Griya SedatiIndah Sidoar
jo</td>
<td>031-8683838</td>
<td>Diah Ayu Komalasari</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>50</td>
<td></td>
<td>MERAPI UTAMA PHARMA CABANG SIDOARJO PT</
td>
<td>Cabang</td>
<td></td>
<td>Jl. Raya Waru I A Kompl Pergudangan Nil
a Alam Sidoarjo</td>
<td>031-8536774</td>
<td>Rocky Fahriar Re A, S.Farm,Apt</td>
<td>L</td>
<td>KP.01.03.1.3.4589</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>51</td>
<td></td>
<td>NUSASARI DINAMIKA PT</td>
<td></td>
<td></td>
<td>Ruko Kedungturi Blok A-4Jl. Kedungturi
33 Sepanjang Sidoarjo</td>
<td></td>
<td>Dewi Indah Safitri</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>52</td>
<td></td>
<td>PENTA VALENT PT</td>
<td>Cabang</td>
<td>098.752/PBF.Cab/P. I/13.10/2009 </td>
<td>Jl. Berbek Industri V/8 Waru Sidoarjo</
td>
<td></td>
<td>Nur Jannah </td>
<td>P</td>
<td>SIK AA 551.41/301/404.3.2/2009
31 Ag
s 2009</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>53</td>
<td></td>
<td>PERDANA ANUGRAH SEJAHTERA PT</td>
<td>Pusat</td>
<td>YF.05.DJ.I.PBF.279
30 Mei 2006</td>
<td>Jl. Delta Raya Selatan 45 Deltasari Baru
Sidoarjo</td>
<td></td>
<td>Laily Rahmawati</td>
<td>P</td>
<td>0501.831AA</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>54</td>
<td></td>
<td>PERMATA DELTA AGUNG PT</td>
<td></td>
<td></td>
<td>Perum Pesona Permata Gading C-14 Sidoarj
o</td>
<td>031-8059775</td>
<td>Ida Elijani</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>55</td>
<td></td>
<td>PHARMINDO RIMPANG KOKOH PRATAMA ARTHA PT
</td>
<td>Cabang</td>
<td>35121/PBF/V/99</td>
<td>Jl. Raya Buncitan 1 A Sedati Juanda Sido
arjo</td>
<td>031-8913475</td>
<td>Dyah Permanasari</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>56</td>
<td></td>
<td>REJEKI MITRA FARMA CABANG SIDOARJO PT</
td>
<td>Cabang</td>
<td>011.35062/PBF/13.10/IX/2003</td>
<td>Jl. Raya Waru Pertokoan Gateway Blok F N
o. 10, 11, 12 Sidoarjo</td>
<td></td>
<td>Martha Satyawati S</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>57</td>
<td></td>
<td>RICHTJI PT</td>
<td>Cabang</td>
<td></td>
<td>Jl. Nanas VII-679 Pondok Candra Sidoarj
o</td>
<td>031-8679852</td>
<td>Rena Puspita Inggawati</td>
<td>P</td>
<td>0502.1733.AA</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>58</td>
<td></td>
<td>SAN PRIMA SEJATI CABANG SIDOARJO PT</td>
<td>Cabang</td>
<td>011.35062/PBF/13.10/III/2010 </td>
<td>Jl. Rajawali 31 Rewin, Waru Sidoarjo</td
>
<td>031-8674556
031-8668282
031-8676331</td>
<td>Nurul Mufidah</td>
<td>P</td>
<td>0502.1733.AA</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>59</td>
<td></td>
<td>SEDATI GUNUNG MULIA PT</td>
<td>Pusat</td>
<td>YF.05.DJ.I.PBF.938 30 Nop 2006</td>
<td>Komp.pergudangan Meiko Abadi blok A-23
Wedi Gedangan Sidoarjo</td>
<td></td>
<td>Ina Puspitasari</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>60</td>
<td></td>
<td>SINAR INTERMARK PT</td>
<td>Cabang</td>
<td>28.33010/PBF.Cab/13.10/IX/2007 </td>
<td>Jl. Berbek Industri III no.7 Waru
Si
doarjo</td>
<td></td>
<td>Tri Suharyanti </td>
<td>P</td>
<td>30849/Pend/ AA</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>61</td>
<td></td>
<td>SINAR NIAGA SEJAHTERA PT</td>
<td></td>
<td></td>
<td>Jl. Ngelom Megare 573 Sidoarjo</td>
<td></td>
<td>Rachmawati Fitria </td>
<td>P</td>
<td>503.445/0158/SIK AA/436/VI/2006</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>62</td>
<td></td>
<td>SUN HODOS PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Taruna 217 Wage Taman Sidoarjo</td>
<td>031-70583411</td>
<td>Emi Zul Affiatur Rochmah</td>
<td>P</td>
<td>551.41/271/404.3.2/2008</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>63</td>
<td></td>
<td>TIARA RUCITA PHARMINDO PT</td>
<td>Pusat</td>
<td>YF.05.DJ.I.PBF.767 4 Okt 2006</td>
<td>Ruko Taman Aloha no.6 Lt 2 Sidoarjo</td>
<td>031-8554900</td>
<td>Lilik Hartini</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>64</td>
<td></td>
<td>TRI SAPTA JAYA CAB. SIDOARJO</td>
<td>Cabang</td>
<td>P2T/14/03.11/VII/ 2010
12 Juli 2010
</td>
<td>Ruko Gateway Blok F/10-12 Raya Waru Sido
arjo</td>
<td>031-8554530</td>
<td>Nur Madusari, S.Farm, Apt</td>
<td>P</td>
<td>KP.01.03.1.3.1742</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>65</td>
<td>KAB. SITUBONDO</td>
<td></td>
<td>PAPAN SEHAT SEJAHTERA PT</td>
<td>Pusat</td>
<td>Kampung Sabrang No.9 RT.02 RW.01 Wringin
anom Panarukan Situbondo</td>
<td></td>
<td>Noviyanti Khodaniah </td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>66</td>
<td></td>
<td>PRASETYA PRATAMA JAYA PT</td>
<td></td>
<td></td>
<td>Jl. Raya Kotim Besuki Situbondo</td>
<td>(0338) 892692</td>
<td>Yanu Resmala Ningrum </td>
<td>P</td>
<td>440/832/431.201.2.2/2006</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>67</td>
<td>KAB. SUMENEP</td>
<td></td>
<td>DANA UTAMA PT</td>
<td>Cabang</td>
<td>35070/PBF/I/94</td>
<td>Jl. Dr. Wahidin No. 47-49 Sumenep </td>
<td>(0328) 661437</td>
<td>Sa?iya </td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>68</td>
<td></td>
<td>GENTHA BERLIAN PT</td>
<td>Pusat</td>
<td>YF. 05. DJ . I. PBF . 123 6 Februari 200
7</td>
<td>Jl. Masa Lembu III / 4 Pamaloha Sumenep
</td>
<td>Telp. (0328</td>
<td>Rachmad Tulus S</td>
<td>L</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>69</td>
<td>KAB. TUBAN</td>
<td></td>
<td>SUMBER DWI JAYA PT</td>
<td></td>
<td></td>
<td>Jl. Ikan Kakap 5 Tuban</td>
<td>(0356) 327788</td>
<td>Maimunah</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>70</td>
<td>KAB. TULUNGAGUNG</td>
<td>35-470</td>
<td>REJEKI MITRA FARMA PT</td>
<td>Cabang</td>
<td>35062/PBF/Cab-5/III/02</td>
<td>Jl. KH Agus Salim 11 Blok A.24-25 Tulung
agung</td>
<td></td>
<td>Wiwin Widiyawati</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>71</td>
<td></td>
<td>SAKAJAJA MAKMUR ABADI CAB TULUNGAGUNG</t
d>
<td>Cabang</td>
<td></td>
<td>Jl. Yos Sudarso 10 Tulungagung</td>
<td></td>
<td>Fais Kristiyani</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>72</td>
<td>KOTA BATU</td>
<td></td>
<td>INDO KARYA ASIFA PT</td>
<td></td>
<td></td>
<td>Jl. Sumber Gondo I Batu</td>
<td></td>
<td>Dewi Isminati</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>73</td>
<td>KOTA BATU</td>
<td></td>
<td>MAS ROSE CITRA ABADI PT</td>
<td>Pusat</td>
<td>392/Menkes/SK/III/2005 </td>
<td>Jl. Raya Gangsiran Wetan 9 Junjero Batu<
/td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>74</td>
<td>KOTA BLITAR</td>
<td></td>
<td>AL-NITA PT</td>
<td>Pusat</td>
<td>819/Menkes/SK VII/2004</td>
<td>Jl. Kiprah Blok III No. 12 Blitar
</t
d>
<td>(0342) kota 7707077, 814988</td>
<td>Eko Kustyanto</td>
<td>L</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>75</td>
<td></td>
<td>HUDIAN LESTARI MAKMUR PT</td>
<td>Pusat</td>
<td>399/Menkes/SK/VI/2006</td>
<td>Jl. Merdeka No.68 Jabung Talun Blitar</t
d>
<td></td>
<td>Sri Wulan Ningsih</td>
<td>P</td>
<td>0501.2657.AA</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>76</td>
<td>KOTA KEDIRI</td>
<td></td>
<td>BAHTERA TALENTA JAYA PT </td>
<td>Cabang</td>
<td>351117/PBF/IV/99 22 April 1999</td>

<td>Jl. Semeru 182 Kediri</td>
<td></td>
<td>I Nengah Astika</td>
<td>L</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>77</td>
<td></td>
<td>BHAKTI USAHA PURNA WIRA PT</td>
<td></td>
<td></td>
<td>Jl. Dandangan III/28 Kediri</td>
<td></td>
<td>Ny. Sektyowati </td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>78</td>
<td></td>
<td>BINA SAN PRIMA CAB KEDIRI PT</td>
<td>Cabang</td>
<td>078.32052/PBF.Cab/P.1/ 3.04/VIII/2009</t
d>
<td>Jl. Wachid Hasyim 63 Kediri </td>
<td>0354-779375</td>
<td>Nurjanah </td>
<td>P</td>
<td>446/7094/419.41/2008</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>79</td>
<td></td>
<td>DAYA MANUNGGAL AFIJAYA PT</td>
<td>Cabang</td>
<td>442/2883/111.5/2007</td>
<td>Jl. Dandangan II/14A Kediri</td>
<td></td>
<td>Simuarsih . S</td>
<td>P</td>
<td> 17505/ Pend / AA</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>80</td>
<td></td>
<td>DOHO PT</td>
<td>Cabang</td>
<td>35054/PBF/PP-1/III/97</td>
<td>Jl. Dandangan II/14 Kediri</td>
<td></td>
<td>Dwi Widarti </td>
<td>P</td>
<td>446/6790/419.41/2006</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>81</td>
<td></td>
<td>ENSEVAL PUTERA MEGATRADING CAB KEDIRI PT
</td>
<td>Cabang</td>
<td>065.927/PBF.Cab/P.1/13.4/X/2008</td>
<td>Jl. Semeru 25 B Kediri</td>
<td></td>
<td>Suiandari </td>
<td>P</td>
<td>446/356/419.41/2008</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>82</td>
<td></td>
<td>JUNGER FARMA DISTRIBUSI PT</td>
<td></td>
<td></td>
<td>Jl. Raya Persada Sayang No. 2 Kediri </t
d>
<td> (0354) 773437</td>
<td>Indah Wahyuningsih </td>
<td>P</td>
<td>SIAA 111.6/13/SIAA/ 321/00016//I/05</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>83</td>
<td></td>
<td>MILLENIUM PHARMACON INTERNASIO-NAL TBK</
td>
<td>Cabang</td>
<td>20.31009/PBF.Cab/P1/13 041/VI/2007</td>
<td>Jl. Kuwak Utara II / 11 Kediri</td>
<td></td>
<td>Hendro Koeswantoro </td>
<td>L</td>
<td>446/916/419.41/2004</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>84</td>
<td></td>
<td>MITRA FARMA ANUGERAH LESTARI PT</td>
<td>Pusat</td>
<td>YF.05.DJ.I.PBF.648 13 Agustus 2007</td>
<td>Jl. Slamet Riadi 17 Kediri</td>
<td> (0354) 697471</td>
<td>Ai Rosiyana</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>85</td>
<td></td>
<td>Cabang</td>
<td>008.33010/PBF/13.04.1/VI / 2003</td>
<td>Jl. Slamet Riadi 16 Kediri</td>
<td></td>
<td>Endang Srifatmahwati </td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>86</td>
<td></td>
<td>TINALAN ANDATU LESTARI PT </td>
<td>Cabang</td>
<td>07.01/I/184/09
8-4-2009
</td>
<td>Jl. IBH Pranoto (Mauni) no. 11 A Kediri<
/td>
<td>0354-696523-696732</td>
<td>Santi Utami </td>
<td>P</td>
<td>SIK 446/1274/419.41/2008</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>87</td>
<td>KOTA MADIUN</td>
<td></td>
<td>ANDALAS PUTERA MANDIRI PT</td>
<td>Cabang</td>
<td>015.PBF.165/Cab/13.03/IX/ 2006</td>
<td>Jl. Thamrin No.61 Madiun</td>
<td></td>
<td>Farida Kushartanti</td>
<td>P</td>
<td> 49193/Pend/AA</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>88</td>
<td></td>
<td>GUNUNG KENCANA MULYA PT</td>
<td>Pusat</td>
<td>490/Menkes/SK/IV/2004</td>
<td>Jl. Perum Bumi Mas Blok J/13 Madiun</td>
<td></td>
<td>Susi Wijayanti </td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>89</td>
<td></td>
<td>INDOFARMA GLOBAL MEDIKA PT</td>
<td>Cabang</td>
<td>004.31391/PBF/13.03/IV/ 2003</td>
<td>Jl. Setya Bakti 17 Madiun</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>90</td>
<td></td>
<td>KIMIA FARMA TRADING CABANG MADIUN PT 035
1 465350</td>
<td>Cabang</td>
<td>P2T/44/03.11/XI/2010 18-11-2010</td>
<td>Jl. Setiabudi no. 10 Kota Madiun</td>
<td></td>
<td>Andika Feriosa </td>
<td>L</td>
<td>503/1972/401.103/AA 153/2010</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>91</td>
<td></td>
<td>KPRI HUSADA SEJAHTERA PT</td>
<td></td>
<td></td>
<td>Jl. Sumbawa No. 11 Madiun</td>
<td></td>
<td>Frensikatua Ariyanti </td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>92</td>
<td></td>
<td>LADY PHARMINDO PT</td>
<td>Cabang</td>
<td>35132/PBF/XII/99</td>
<td>Jl. Sulawesi 16 A Madiun</td>
<td></td>
<td>Sri Yudho Endang P.</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>93</td>
<td></td>
<td>LIA MITRA USAHA PT</td>
<td>Pusat</td>
<td>HK.07.01/I/268/10 </td>
<td>Jl. Cokroaminoto 102 Kota Madiun</td>
<td> 0351-463549</td>
<td>Drs. Bambang Soemitro Abdoellah, Apt </t
d>
<td>L</td>
<td>SIK2569/B tg 30 mei 1979</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>94</td>
<td></td>
<td>MERAPI UTAMA PHARMA CAB MADIUN PT </td>
<td>Cabang</td>
<td>090.31027/PBF.Cab/P.1/13. 3/V/2009</td>
<td>Jl. Tanjung Raya 42 Madiun
</td>
<td>0331 ? 453019
0351-467100</td>
<td>Marlilis Rosana </td>
<td>P</td>
<td>SIKAA 503/838/401.103/AA. 5/2009 tg 13-4
-2009</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>95</td>
<td></td>
<td>PHARMINDO RIMPANG KOKOH DWI ARTHA PT</td
>
<td></td>
<td></td>
<td>Jl.Jl. Manggar Manis 3 Madiun </td>
<td>0351-458442</td>
<td>Feria Purna Dwiati </td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>96</td>
<td></td>
<td>RAJAWALI NUSINDO PT</td>
<td>Cabang</td>
<td>24.902/PBF.Cab/13.03/P.1/VIII/2007</td>
<td>Jl. Yos Sudarso 29-31 Madiun</td>
<td></td>
<td>Emy Harmawati </td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>97</td>
<td></td>
<td>TETAP JAYA FARMA PT</td>
<td>Pusat</td>
<td>YF. 05. DJ. I. PBF . 316
2 April 2007
</td>
<td>Jl. Tawang Baru No. 9 Madiun </td>
<td> (0351) 491884</td>
<td>Widayati Sudcoro Edi</td>
<td>P</td>
<td> 31012 / Pend / AA</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>98</td>
<td></td>
<td>TJIPTA NIAGA PT GABUNG JADI PPI PT</td>
<td>Cabang</td>
<td>31026/PBF/Cab-21/VIII/91</td>
<td>Jl. Dr. Sutomo No. 33 Madiun</td>
<td></td>
<td>Yohani Widyaningsih </td>
<td>P</td>
<td>44059/Pend/AA Tetap</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>99</td>
<td></td>
<td>WAHYU MITRA SEJATI PT</td>
<td>Cabang</td>
<td>060.131 4/PBF.Cab/13.1 /IV/2005</td>
<td>Jl. Margahayu No. 33 Madiun</td>
<td></td>
<td>Lidia Sitepu </td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>100</td>
<td>35-251</td>
<td>Cabang</td>
<td>35062/PBF/Cab-4/VIII/01 6 -8 - 2001</td>
<td>Jl. Raya Tiron 64 Nglames Kab. Madiun</t
d>
<td></td>
<td>Lanawati</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>101</td>
<td></td>
<td>SAKAJAJA MAKMUR ABADI CAB MADIUN</td>
<td>Cabang</td>
<td>088.617/PBF.Cab/13.15/V/2009 </td>
<td>Jl. Raya Solo 5 B/Kav 4 RT 18 RW 06 Kang
sen Jiwan Madiun</td>

<td></td>
<td>Novi Kristiyani</td>
<td>P</td>
<td>19.08/402.102/SIKAA/III/2009 tgl 12-3-20
09</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>102</td>
<td></td>
<td>SINAR INTERMARK CAB MADIUN</td>
<td>Cabang</td>
<td>099.33010/PBF.Cab/13.15/V/2009 </td>
<td>Jl. Raya Solo no. 154 Kab Madiun</td>
<td>0351-452462</td>
<td>Fika Astiana Risca Putri</td>
<td>P</td>
<td>23.08/402.102/SIKAA/IX/2009 1/9/2009</td
>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>103</td>
<td>KOTA MALANG</td>
<td></td>
<td>ADI BUANA CITRA DHARMALA PT</td>
<td></td>
<td></td>
<td>Jl. Candi Panggung 1 G</td>
<td></td>
<td>Sulistinah Ningsih </td>
<td>P</td>
<td>446.AA/128/SIK/35. 3. 306/2007</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>104</td>
<td></td>
<td>ALOHA JAYA PT</td>
<td>Cabang</td>
<td>35159/PBF/01 29 Januari 2001</td>
<td>Jl. Suropati 40 Malang</td>
<td></td>
<td>Siti Marfuatul Fitriyah </td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>105</td>
<td></td>
<td>ANUGERAH PHARMINDO LESTARI CABANG MALAN
G PT</td>
<td>Cabang</td>
<td>P2t/48/03.11/XI/2010 26-11-2010</td>
<td>Jl. Taman Tenaga Kav 6 Kota Malang</td>
<td> 0341-417350</td>
<td>Yuni Mariyana, Sfarm, Apt </td>
<td>P</td>
<td>KP.01.01.1.3.1948</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>106</td>
<td></td>
<td>ANUGRAH ARGON MEDIKA CAB MALANG PT</td>
<td>Cabang</td>
<td>067.056/PBF.Cab/P.1/3.06/VI/2009</td>
<td>Jl. Pulosari no.6 Malang</td>
<td></td>
<td>Rulitasari, Amd,Farm</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>107</td>
<td></td>
<td>ARTA BOGA CEMERLANG PT </td>
<td>Cabang</td>
<td>030.1417/PBF.Cab/13. 0/III/2004</td>
<td>Jl. Sunandar Priyosudarmo 27 Malang </t
d>
<td> (0341) 496777</td>
<td>Dra. Liana Gunawan, Apt </td>
<td>P</td>
<td> 5016/B</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>108</td>
<td></td>
<td>BENTENG GADING GEMILANG PT</td>
<td></td>
<td></td>
<td>Jl. Titan VI/R.11 Malang</td>
<td></td>
<td>Nur Hidayati </td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>109</td>
<td></td>
<td>BINA SAN PRIMA PT</td>
<td>Cabang</td>
<td>046.32052/PBF Cab/13.06/ VIII/2004. </td
>
<td>Jl. A. Yani 138 Malang </td>
<td></td>
<td>Ferina Andriyas </td>
<td>P</td>
<td>121/SIK/35.73.306</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>110</td>
<td></td>
<td>CIPTA NIAGA PT (GABUNG ANG ANTI NAMA PPI
PT)</td>
<td>Cabang</td>
<td>044.1314/PBF Cab/13.06/ VII/ 2004</td>
<td>Jl. A. Yani Utara 2 Malang</td>
<td></td>
<td>Sunarsih</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>111</td>
<td></td>
<td>DAYA MUDA AGUNG CAB MALANG PT </td>
<td>Cabang</td>
<td>068.592/PBF.Cab/P.2/ 3.06/V/2009</td>
<td>Jl. Terusan Batubara bo. 30C Kota Malang
</td>
<td>0341-4345513/14</td>
<td>Tri Astuti Saputro, SFar, Apt </td>
<td>P</td>
<td>SP.KP. KP.01.03.1.3.0749</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>112</td>
<td></td>
<td>DISTIVERSA BUANAMAS CAB MALANG PT </td>
<td>Cabang</td>
<td>P2T/10/03.11/VI/2010 8 Juni 2010</td>
<td>Jl. Kunir no.5 Malang Malang </td>
<td>0341-356080</td>
<td>Neneng Yuliana </td>

<td>P</td>
<td>SIK 446.AA.212/SIK/35. 06/2009</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>113</td>
<td></td>
<td>DOS NI ROHA PT</td>
<td>Cabang</td>
<td>069.31032/PBF.Cab/1 26/ VIII/2005</td>
<td>Jl. Sultan Agung 22 (lama) Jl. P. Sudir
man 148 Singosari Malang
</td>
<td>Telp. 0341 ? 458636</td>
<td>Rixach Sriany </td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>114</td>
<td></td>
<td>DUTA DWI SARANA PRIMA PT</td>
<td>Pusat</td>
<td>022.35149/PBF.Pusat/13. 6/XII/2003</td>
<td>Jl. Tapak Liman 15 Malang </td>
<td></td>
<td>Ririn Kusumaningrum</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>115</td>
<td></td>
<td>DWILANDRA HIDA UTAMA PT</td>
<td></td>
<td>35058/PBF/VII/92 7 Juli 1992</td>
<td>Jl. Larwo E.30 Malang</td>
<td></td>
<td>Sri Naningsih </td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>116</td>
<td></td>
<td>ENDOJERIS PT</td>
<td></td>
<td></td>
<td>Jl. Andalas Tengah no.23 Malang</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>117</td>
<td></td>
<td>FITALAB UTAMA KARYA PT 0341- 4345443</t
d>
<td>Pusat</td>
<td>HK.07.01/I/108/10 17 Maret 2010</td>
<td>Jl. Tenaga Tengah No.5 Malang </td>
<td>Telp. 0341 ? 497172</td>
<td>R Koenarno </td>
<td>L</td>
<td>:446.AA/258/ K/35.73.306/2009</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>118</td>
<td></td>
<td>GALA JAYA RAYA PT</td>
<td>Cabang</td>
<td>31116/PBF/Cab 11/XI/99</td>
<td>Jl. Timah 10 Malang (alamat baru)</td>
<td></td>
<td>Fajar Arifianto </td>
<td>L</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>119</td>
<td></td>
<td>GRAHA KANDHI FARMA</td>
<td>Cabang</td>
<td>350044/PBF/PP-2/III/94 8 Maret 1994</td>
<td>Jl. Cipunegara no.12 Malang</td>
<td></td>
<td>Heny Sukatmi </td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>120</td>
<td></td>
<td>GREAT MATARAM PT CABANG MALANG</td>
<td>Cabang</td>
<td>003.33021/PBF/13.06.1 IV/2003. </td>
<td>Jl. Batanghari 3 Malang</td>
<td></td>
<td>Kustia M</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>121</td>
<td></td>
<td>GUNTOR MISRI SENTOSA PT</td>
<td>Pusat</td>
<td>023.35115/PBF.Pusat/13. 6/XII/2003</td>
<td>Jl. Tapak Liman 15 Malang</td>
<td></td>
<td>Linda Ikaning W </td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>122</td>
<td></td>
<td>HANJAYA PERKASA LESTARI FARMA PT</td>
<td></td>
<td></td>
<td>Jl. Papandayan No.10 Malang</td>
<td></td>
<td>Dewi Utarini </td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>123</td>
<td></td>
<td>HAPEEL PHARMINDO PT</td>
<td></td>
<td></td>
<td>Jl. Bukit Dieng B No.1 Malang .</td>
<td> 0341 ? 557555</td>
<td>Ninik Wiji Astuti </td>
<td>P</td>
<td>0501.8760.AA</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>124</td>
<td></td>
<td>HASMA JAYA AGUNG PT</td>
<td>Cabang</td>
<td>35133/PBF/XII/99 29 Desember 1999</td>
<td>Jl. Danau Singkarak no.E.3.A.12 Malang<
/td>
<td></td>
<td>Mundari </td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>125</td>
<td></td>
<td>HIKMAT SEJATI GEMILANG FARMA PT</td>
<td>Cabang</td>
<td>35144/PBF/VI/00
14 Juni 2000</td>
<td>Jl. Raya Langsep no.63 Malang</td>
<td></td>
<td>I.G.Santoso </td>
<td>L</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>126</td>
<td></td>
<td>HUSENA PHARMACY PT</td>
<td></td>
<td></td>
<td>Jl. J.A.Suprapto no.62 Malang</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>127</td>
<td></td>
<td>INDOFARMA GLOBAL MEDIKA PT CAB.MALANG</t
d>
<td>Cabang</td>
<td>026.31391/PBF.Cab/P. /13.06/IV/2010</td>
<td>Jl. Sunandar Priyosudarmo 20 D Malang </
td>
<td>0341 402150/51 </td>
<td>Ulfah </td>
<td>P</td>
<td>436.AA/146/SIK/35. 3.306/2008</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>128</td>
<td></td>
<td>INDOMARCO ADI PRIMA CAB.MALANG</td>
<td>Cabang</td>
<td>31386/PBF/Cab 13/VI/00</td>
<td>Jl. Tenaga Tengah no.55 Malang</td>
<td></td>
<td>Siti Nurul Aini </td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>129</td>
<td></td>
<td>INTAN BASKARA MANDIRI FARMA PT</td>
<td>Cabang</td>
<td>Jl. Sultan Agung no.12 Malang</td>

<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>130</td>
<td></td>
<td>JUNGER FARMA DISTRIBUSI PT</td>
<td>Cabang</td>
<td>018.31336/PBF.Cab/13. 6/XI/2006</td>
<td>Jl. Bantaran Barat II / 37 Malang </td>
<td> Telp. (0341) 496648</td>
<td>Enggar Meia Damayanti </td>
<td>P</td>
<td>0501.912.AA</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>131</td>
<td></td>
<td>KALISTA PRIMA PT</td>
<td>Cabang</td>
<td>050.31075/PBF.Cab/13. 6/IX/2004</td>
<td>Jl. Teluk Etna V / 86 Malang</td>
<td> Telp. (0341) 403534</td>
<td>Yunita Eka Sundari</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>132</td>
<td></td>
<td>KEBAYORAN FARMA CAB MALANG PT</td>

<td>Cabang</td>
<td>33..31016/PBF.Cab/P/3.06/XI/2007</td>
<td>Jl. Hamid Rusdi 93 Malang</td>
<td></td>
<td>Afiah Eko Rahmawati </td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>133</td>
<td></td>
<td>KIMIA FARMA CAB MALANG PT 0341-492787</t
d>
<td></td>
<td></td>
<td>Pondok Blimbing Indah (PBI) Utara IV-2 B
lok A 1/19 Malang</td>
<td></td>
<td>Dadang Wahyu Pramono (AA)</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>134</td>
<td></td>
<td>LAB MEDIKA SEJAHTERA CAB MALANG PT 0341
353396/ 081334480877</td>
<td>Cabang</td>
<td>P2T/22/03.11/VIII/2010</td>
<td>Jl. Kebalen no. 1 B Malang</td>
<td></td>
<td>Sulistyo Dwi Arfiani</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>135</td>
<td></td>
<td>MENSA BINA SUKSES CAB MALANG </td>
<td>Cabang</td>
<td>P2T/11/03.11/VI/2010 24 Juni 2010</td>
<td>Jl. Janti Barat Blok A /48 Kota Malang</
td>
<td>0341-805948-805949</td>
<td>Indah Susilowati </td>
<td>P</td>
<td>446.AA/137/SIK/35. 3.306/2009</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>136</td>
<td></td>
<td>MERAPI UTAMA PHARMA CAB MALANG PT</td>
<td></td>
<td></td>
<td>Jl. Karya Barat no. 5 Malang</td>
<td> 0341-477471</td>
<td>Insari Kusuma Halik </td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>137</td>
<td></td>
<td>MINAROZA FARMA PT </td>
<td>Cabang</td>
<td>442/521/101.5/2010</td>
<td>Jl. Soekarno Hatta no. 7 Malang</td>
<td>0341-497021</td>
<td>Norcholis Zaiban</td>
<td>L</td>
<td> 446.AA/237/SIK/35 73.306/2009</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>138</td>
<td></td>
<td>PANCA HUSADA FARMA PT</td>
<td>Cabang</td>
<td>0830/A/SK/PBF/IV/90 2 April 1990</td>
<td>Jl. Ronggowarsito no.23 Malang</td>
<td></td>
<td>Ninik Winarti </td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>139</td>
<td></td>
<td>PANGESTU FARMINDO MULIATAMA PT</td>
<td>Cabang</td>
<td>35138/PBF/IV/00</td>
<td>Jl. Arjuna 34 Malang (alamat baru) </td>
<td>Telp. (0341) 362873 </td>
<td>Ninik Winarti </td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>140</td>
<td></td>
<td>PARAZELSUS INDONESIA CAB MALANG PT (EKS
DKSH TUNGGAL)</td>
<td>Cabang</td>
<td>P2T/28/03.11/IX/2010</td>
<td>Jl. Hamid Rusdi 103 Malang</td>
<td> 0341-336001</td>
<td>Mamik Winarti</td>
<td>P</td>
<td> 446.AA/196/SIK/35 73.306/2008</td>

<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>141</td>
<td></td>
<td>PARIT PADANG GLOBAL CAB MALANG PT </td>
<td>Cabang</td>
<td>105.763/PBF.Cab/13.0 /I/2010</td>
<td>Jl. Soekarno Hatta No 80 Malang ( Alam
at Baru )</td>
<td>0341-417111/417555</td>
<td>Ani Mulyani</td>
<td>P</td>
<td> 446.AA/266/SIK/35 73.306/2010</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>142</td>
<td></td>
<td>PARTA KARYA PT</td>
<td>Cabang</td>
<td>51104/PBF/PC-7-1 VI/99</td>
<td>Jl. Cipunegara 38 Malang</td>
<td></td>
<td>Elly Indrawati K </td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>143</td>
<td></td>
<td>PENTA VALENT CAB MALANG PT </td>
<td>Cabang</td>
<td>079.752/PBF.Cab/P.1/ 3.06/IV/2010</td>
<td>Jl. Citarum no. 5 Malang</td>

<td>0341-4345700</td>
<td>Dwi Agustinah </td>
<td>P</td>
<td>446.AA/208/SIK/35 73.306/2008</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>144</td>
<td></td>
<td>PRAMUMITRA PHARMA PT</td>
<td>Cabang</td>
<td>35166/PBF/III/01 16 Maret 2001</td>
<td>Jl. Kaliurang Barat 113 Malang</td>
<td></td>
<td>Sukarti</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>145</td>
<td></td>
<td>RAJAWALI NUSINDO PT</td>
<td>Cabang</td>
<td>054.31088/PBF.Cab/1306/ 2005</td>
<td>Jl. Delima No.7 Malang</td>
<td></td>
<td>Dini Regsanti </td>
<td>P</td>
<td>0599.546.AA</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>146</td>
<td></td>

<td>Cabang</td>
<td>35062/PBF/96/Cab 1/PL-1/IX/02</td>
<td>Jl. Tenaga Baru Blok B-II No.16 Malan
g</td>
<td></td>
<td>Endang Rachmawati</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>147</td>
<td></td>
<td>SAMUDRA ARTHA PHARMASINDO PT</td>
<td>Pusat</td>
<td>438/Menkes/SK/IV/2004 1 April 2004</td>
<td>Jl. Pasir Putih 5. Malang </td>
<td>Telp. (0341)40583</td>
<td>Marlina Septiana </td>
<td>P</td>
<td>0501.754.AA</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>148</td>
<td></td>
<td>SANDHANA MUNDI SENTOSA PT</td>
<td>Pusat</td>
<td>301/Menkes/SK/III/20057 Maret 2005</td>
<td>Jl. Pelabuhan Tanjung Mas 1 Malang Telp.
(0341) 835296</td>
<td></td>
<td>Wiwik Hariyati</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>149</td>
<td></td>
<td>SANTA ABADI PT</td>
<td>Pusat</td>
<td>YF.05.DJ.I.PBF.792 5 Nop 2007</td>
<td>Jl. Candi Ngrimbi 19 Malang</td>
<td></td>
<td>Erlin Juni Triastuti </td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>150</td>
<td></td>
<td>SAPTA SARI TAMA CAB MALANG PT</td>
<td>Cabang</td>
<td>095.689/PBF.Cab/13.0/VIII/2009</td>
<td>Jl. Topaz no. 18 Tlogomas Lowok Waru Mal
ang Malang</td>
<td></td>
<td>Latifah Woro Sumoro </td>
<td>P</td>
<td>SIK 446.AA/166/SIK/35. 3.306/2008 24-3 2
008</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>151</td>
<td></td>
<td>SAVERO FARMA PT</td>
<td></td>
<td></td>
<td>Jl. Raya Dieng 32 Malang</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>152</td>
<td></td>
<td>SAWAH BESAR FARMA PT CAB.MALANG</td>
<td>Cabang</td>
<td>31015/PBF/Cab-16/V/01</td>
<td>Jl. Simpang Barito I/1 Malang</td>
<td></td>
<td>Tri Indah Nuryanti </td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>153</td>
<td></td>
<td>Cabang</td>
<td>25.33010/PBF.Cab/13.0 /IX/2007</td>
<td>Jl. Panji Suroso No.20 Malang</td>
<td></td>
<td>Wiwik Gandis R</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>154</td>
<td></td>
<td>TADJUR PUTRA MANDIRI PT</td>
<td>Cabang</td>
<td>35123/PBF/VI/99 24 Juni 1999</td>
<td>Jl. Kesatrian Dalam 22 Malang</td>
<td></td>
<td>Kartini </td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>155</td>
<td></td>
<td>TEMPO PT</td>
<td>Cabang</td>
<td>040.31081/PBF Cab/13.06/ VI/2004</td>
<td>Jl. Raya Tlogo Mas 26 ? 27 Malang</td>
<td> Telp. (0341) 366102 </td>
<td>Sugiarto
Ninik Yuwindar
i </td>
<td>L</td>
<td>49178/Pend/AA
43832/
Pend/AA</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>156</td>
<td></td>
<td>TRISULA MANUNGGAL JAYA PT</td>
<td>Cabang</td>
<td>35042/PBF/VII/91 25 Juli 1991</td>
<td>Jl. Letjen S.Parman 26 Malang
</td>
<td>Telp.(0341) 493472</td>
<td>Filumena Trijanti P </td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>157</td>
<td></td>
<td>TRITAMA JAYA ABADI.PT</td>
<td>Pusat</td>
<td>HK.07.01/I/012/10 8-1-2010</td>
<td>Jl. Sulfat tengah E-16 RT 3 RW 13 Malang
Jawa Timur</td>
<td></td>
<td>Dwi Kesumawanto Sahiyus,SFarm,Apt </td>
<td>L</td>
<td>SP.KP.01.03.1.3.6721</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>158</td>
<td></td>
<td>TUNGGAL SILA FARMAPT GANTI NAMA DKSH TU
NGGAL</td>
<td>Pusat</td>
<td>010.YF.05.DJ.I.PBF.263PBF.Cab/13.06/VI/2
006</td>
<td>Jl. Hamid Rusdi 103 Malang (baru)
</t
d>
<td> Telp. (0341) 328434</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>159</td>
<td></td>
<td>ULTRA BINTANG JAYA PUTRA PT PINDAH KE J
L. TENAGA SELATAN 28 TDK LAPOR & SDH 2 TH TDK ADA KEGIATAN SESUAI SRT BALAI POM
SBY TGL. 8-2-2008 NO.PO.02.01.884.773</td>
<td>Cabang</td>
<td>35108/PBF/V/98 25 Mei 1998</td>
<td>Jl. Sunandar Priyo Sudarmo Kav.A.36 Mala
ng </td>
<td>(0341) 478126, 478127</td>
<td>Pusparini </td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>160</td>
<td></td>
<td>UNITED DICO CITAS CAB MALANG PT 0341 567
611</td>
<td>Cabang</td>
<td>P2T/9/03.11/VI/2010 3 Juni 2010</td>
<td>Jl. Nangka no. 11 Malang</td>
<td></td>
<td>Agus Tutik Irmayanti</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>161</td>
<td></td>
<td>WALUYO AGUNG SEJATI PT</td>
<td>Pusat</td>
<td>Jl. Kelud No.12 Malang</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>162</td>
<td></td>
<td>WIGO PT</td>
<td>Cabang</td>
<td>042.311/PBF Cab/13.06/VII/ 2004</td>
<td>Jl. WR Supratman 6 Malang </td>
<td> Telp. (0341) 407209</td>
<td>Nanik Susilowati </td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>163</td>
<td></td>
<td>ZAIFAZA FARMA PT</td>
<td>Cabang</td>
<td>35124/PBF/VIII/99 18 Agustus 1999</td>
<td>Jl. Sukarno Hatta 7 Mojolangu
Malang<
/td>
<td></td>
<td>Enny Wasaningsih </td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>164</td>
<td></td>
<td>ANTAR MITRA SEMBADA CAB MALANG PT </td>
<td>Cabang</td>
<td>005.31077/PBF.Cab./P 1/ 13.06/IV/2007 </
td>
<td>Jl. Tampomas 11 A Oro-oro Dowo, Malang
</td>
<td>0341-352254,352253</td>
<td>Mardhiyah, Sfarm,Apt</td>
<td>P</td>
<td> KP.01.03.1.3.1279</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>165</td>
<td></td>
<td>ENSEVAL PUTRA MEGATRADING TBK CAB MALAN
G PT </td>
<td>Cabang</td>
<td>P2T/2/03.11/V/2010 3 Mei 2010</td>

<td>Jl. Industri no. 90 Ds Mangliawan Pakis
Kab Malang</td>
<td>0341-792800</td>
<td>Ersy Kristanty</td>
<td>P</td>
<td> 077/Kab.Mlh/SIKAA X/07</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>166</td>
<td></td>
<td>TRI SAPTA JAYA CAB MALANG PT </td>
<td>Cabang</td>
<td>P2T/7/03.11/V/2010 25 Mei 2010</td>
<td>Jl. Raya Karanglo no. 73 A Banjararum Si
ngosari- Malang</td>
<td>0341-478777</td>
<td>Mafik Ulama</td>
<td>L</td>
<td>05/Kab Mlg/SIKAA/IV/2010</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>167</td>
<td>KOTA PASURUAN</td>
<td></td>
<td>SELES GLOBAL FARMA PT</td>
<td>Pusat</td>
<td>HK.07.01/I/267/09 22 Mei 2009</td>
<td>Dsn Talun 03/03 Ds Gununggangsir Kec Bej
i Kab Pasuruan</td>
<td> 0343-658693-94</td>
<td>Nining Kristiani</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>168</td>
<td>KOTA PROBOLINGGO</td>
<td></td>
<td>WALISONGO PT</td>
<td>Cabang</td>
<td>063.193/PBF.Pusat/13.08/V/ 2005</td>
<td>Jl. Brantas 175 Kademangan Probolinggo
</td>
<td></td>
<td>Yuni Candra Hapsari</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>169</td>
<td>KOTA SURABAYA</td>
<td>35-001</td>
<td>ACACIA MITRA ABADI PT</td>
<td>Cabang</td>
<td>35150/PBF/IX/00 26 September 2000</td>
<td>Jl. Raya Panjang Jiwo Permai 1B-21 Kompl
Pertokoan Delta Permai Blok B-11 Surabaya</td>
<td></td>
<td>Erly Budiwati Indrarim </td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>170</td>
<td></td>
<td>ADITYA FARMATAMA PT</td>
<td>Cabang</td>
<td>51002/PBF/Cab-3/VII/99 26 Juli 1999</td>
<td>Jl. Rungkut Asri Barat XII/31 Surabaya</
td>
<td></td>
<td>Ani Suyatmi </td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>171</td>
<td></td>
<td>AL-KAHFI</td>
<td>Pusat</td>
<td>052.35183/PBF.Pusat/13.0 /XI/2004</td>
<td>Jl. Ploso Baru 190 Sby </td>
<td>Telp. 3812503</td>
<td>Pujiastutik </td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>172</td>
<td>35-002</td>
<td>ALODIA DIVA NUSANTARA PT</td>
<td>Pusat</td>
<td>Jl. Rungkut Mejoyo Utara VII/AD5 Surabay
a (K)Jl. Tenggilis Timur II/49, Surabaya (G)</td>
<td></td>
<td>Alif Fidias </td>
<td>L</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>173</td>
<td></td>
<td>ALVINDO JUHAN LESTARI PT </td>
<td>Pusat</td>
<td>HK.07.01/I/275/10 11 Agustus 2010</td>
<td>Jl. Raya Kalirungkut No.1-3 Blok L-11-12
Komplek Ruko Megah Raya Blok L 11-12 Surabaya</td>
<td>031-8708925</td>
<td>Henny Wardhani Indrajaya </td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>174</td>
<td></td>
<td>AMADEA DEVINA FARMA PT</td>
<td></td>
<td></td>
<td>Jl. Rungkut Mejoyo Utara VII Blok AD/5 S
urabaya</td>
<td></td>
<td>Ardyan Sukma Prakarsa</td>
<td>L</td>
<td> 503.446/0011/S K.AA/436.4.8/ O/2004</td
>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>175</td>
<td></td>
<td>ANEKA USAHA ?KARYA KITA? KOPERASI</td>
<td></td>
<td></td>
<td>Jl. Rungkut Industri Raya No.6 Surabaya
</td>
<td>Telp. (031) 8437345, 8437347</td>
<td>Harsono Irawan </td>
<td>L</td>
<td>6248/B</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>176</td>
<td></td>
<td>ANJASMORO INDAH PT</td>

<td>Pusat</td>
<td>Jl. Rungkut Mejoyo Utara VII/AD5 (K)Jl.
Tenggilis Timur II/49, Surabaya (G)</td>
<td></td>
<td>Hendrawati B</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>177</td>
<td>35-003</td>
<td>ANTAR MITRA SEMBADA CAB SURABAYA PT</td
>
<td>Cabang</td>
<td></td>
<td>Jl. Kupang indah VIII/61 Surabaya</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>178</td>
<td></td>
<td>ANTAR MITRA SEMBADA CAB SURABAYA 2 PT </
td>
<td>Cabang</td>
<td>091.197/PBF.cab/P.2/13 01.2/III/2010</td
>
<td>Jl. Raya Kupoang Baru no. 10 Surabaya </
td>
<td>031-7320230-31-35</td>
<td>Amaliyah Rachmawati Juhairi </td>
<td>P</td>
<td>503.446/7086/0 16/SIKAA/436. 3/I/2010</t
d>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>179</td>
<td></td>
<td>ANUGRAH ARGON MEDICA CABANG SURABAYA I
PT </td>
<td></td>
<td></td>
<td>Jl. Klampis Jaya No.31 J-K-L Surabaya </
td>
<td>031 5935542-5935543</td>
<td>Liza Yudistira Yusan,-SFarm, Apt </td>
<td>P</td>
<td>KP.01.031.3.6022</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>180</td>
<td></td>
<td>ANUGRAH ARGON MEDIKA CABANG SURABAYA 2
PT </td>
<td>Cabang</td>
<td>P2T/1/03/11/IV/2010 27-4-2010</td>
<td>Jl. Mayjen Sungkono Perum Kris Kencana H
-2 Surabaya (Kantor ) Gudang 1 :Jl. Mayjen Sungkono Perum Kris Kencana H-2 Sura
baya Gudang 2 :Jl. Rungkut Industri I/9C </td>
<td>031-5671348-5663688</td>
<td>Gudang 1 : Aprilia Palupy, Sfarm, Apt ,
Gudang 2 : Pramita Ariyasa,SFarm, Apt </td>
<td>P</td>
<td>SP.KP.01.03.1.3 1905 23 Maret 2010
SP.KP. 01.031.3.1746 19 maret 2010</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>181</td>
<td></td>
<td>ANUGRAH HASIL BERSAUDARA PT</td>
<td></td>
<td></td>
<td>Jl. Medokan Ayu MA-IL No. 34 YKP Surabay
a</td>
<td></td>
<td>Sri Wahyuni </td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>182</td>
<td></td>
<td>ANUGRAH INDAH SEJAHTERA PT</td>
<td>Pusat</td>
<td>1152/Menkes/SK/X/2004 </td>
<td>Jl. Griya Kebraon Selatan 2 B / 24
Su
rabaya </td>
<td>Telp.7670456</td>
<td>Erna M</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>183</td>
<td></td>
<td>ANUGRAH MITRA JAYA PT</td>
<td>Pusat</td>
<td>196/Menkes/SK/II/2005</td>
<td>Jl. Panjangjiwo 46-48 Ruko Panji Makmur
A-31 Sby. </td>
<td> Telp. 8482312</td>
<td>Puspa Novianti </td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>184</td>
<td></td>
<td>ANUGRAH WIRASTAMA PT</td>
<td></td>
<td>35040/PBF/PP-2/III/98 </td>
<td>Jl. Barata Jaya XVIII/37 (lantai 1) Sura
baya (alamat baru)</td>
<td></td>
<td>Soedartinah</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>185</td>
<td></td>
<td>ARTISTAMA ANDALAN MANDIRI PT</td>
<td>Cabang</td>
<td>35099/PBF/VII/97</td>
<td>Jl. Bhakti Husada III/1 Surabaya</td>
<td></td>
<td>Sudarmiyanti </td>
<td>P</td>
<td>111.6/13/SIAA</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>186</td>
<td></td>
<td>ARYAGUNA CIPTA SEJAHTERA PT</td>
<td>Pusat</td>
<td>1236/Menkes/SK/X/2001 </td>
<td>Jl. Rungkut Kidul IV Blok I No.8 Suraba
ya</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>187</td>
<td></td>
<td>ASITA SUKSES ABADI PHARMINDO PT</td>
<td>Pusat</td>
<td>HK.07.01/I/047/09
29-1-2009</td>
<td>Jl. Medokan Ayu MA I A no.1 Surabaya</td
>
<td></td>
<td>Iin Sayektiningsih </td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>188</td>
<td></td>
<td>ASRI PANDUNUSA PT</td>
<td></td>
<td></td>
<td>Jl. Manyar Jaya VIII/C 125 Surabaya</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>189</td>
<td></td>
<td>ASTAKARYA CIPTAMANDIRI PT</td>
<td>Cabang</td>
<td>35106/PBF/III/98 </td>
<td>Jl. Barata Jaya XVIII/37 (lantai dasar),
Surabaya </td>
<td></td>
<td>Nany Harmijanti </td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>190</td>
<td></td>
<td>ASTRO MEGA FARMA PT</td>
<td>Cabang</td>
<td>Jl. Kedalsari Selatan 16 Surabaya</td>
<td></td>
<td>Lilis Kustiani </td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>191</td>
<td></td>
<td>BARITO BUDI PHARMINDO PT</td>
<td>Cabang</td>
<td>31212/PBF/Cab-1/XI/95 </td>
<td>Jl. Jemusari Selatan VII/20 22 Surabaya
</td>
<td></td>
<td>Lulus Pinuji</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>192</td>
<td></td>
<td>BAYACO AGUNG PT</td>
<td>Cabang</td>
<td>35110/PBF/VIII/98</td>
<td>Jl. Margomulyo Industri IV Blok G No.14

-16 Surabaya</td>
<td></td>
<td>Puspitaa Sariani </td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>193</td>
<td></td>
<td>BAYU BAHTERA MULYA PT MENJADI DIAN ADYT
AMA SENTOSA PT
</td>
<td>Cabang</td>
<td>35119/PBF/V/99 </td>
<td>Jl. Jetis Kulon I/1 Surabaya</td>
<td></td>
<td>I Nengah Astika </td>
<td>L</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>194</td>
<td></td>
<td>BEKASURYA PERDANA PT</td>
<td>Cabang</td>
<td>35076/PBF/XII/94 </td>
<td>Jl. Penjaringan Sari II B / 11 Surabaya<
/td>
<td></td>
<td>Endah Srikusrini </td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>195</td>
<td></td>
<td>BELINDO FARMA PT</td>
<td>Cabang</td>
<td>35027/PBF/II/1991</td>
<td>Jl. Raya Darmo 143 Surabaya</td>
<td></td>
<td>Prasetya Budiawan </td>
<td>L</td>
<td>3811/B</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>196</td>
<td></td>
<td>BENZENA PT</td>
<td>Cabang</td>
<td>35004/PBF/PP-1/IV/91</td>
<td>Jl. Gembong Tebasan No. 14 Surabaya</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>197</td>
<td></td>
<td>BERSAUDARA SEJAHTERA UTUH PT </td>
<td>Pusat</td>
<td>HK.07.01/I/120/10 </td>
<td>Jl. Ruko Segi Delapan I no. A-871 Suraba
ya</td>
<td>031 -7319808-031 70206302</td>
<td>Roosyka Wahyuny, SSi, Apt </td>
<td>P</td>
<td>SP.KP.01.01.1.2 6482</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>198</td>
<td></td>
<td>BETA PHARMINDO SEMPURNA PT</td>
<td></td>
<td></td>
<td>Jl. Sriwijaya No. 46 Surabaya</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>199</td>
<td></td>
<td>BHAKTI GUNA SARANA PT CABANG SURABAYA</
td>
<td>Cabang</td>
<td>002/31464/PBF/13.01.1/ V/2003</td>
<td>Jl. Gayungan PTT 57 A Surabaya</td>
<td></td>
<td>Catur Riyadi</td>
<td>L</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>200</td>
<td></td>
<td>BHAKTI HUSADA KPRI</td>
<td>Cabang</td>
<td>35125/PBF/VIII/99 </td>
<td>Jl. Dukuh Setro XI/2 Surabaya</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>201</td>
<td></td>
<td>BHAKTI PERSADA SAUDARA PHARMA PT</td>
<td>Cabang</td>
<td>35151/PBF/X/00</td>
<td>Jl. Pucang Sewu No.17 Surabaya</td>
<td></td>
<td>M. Djuliantono </td>
<td>L</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>202</td>
<td></td>
<td>BIMA PERKASA IKERIMA PT</td>
<td>Cabang</td>
<td>35011/PBF/PP-1/III/98</td>
<td>Jl. Barata Jaya XVIII No. 2 Surabaya</td
>
<td></td>
<td>Wieik Satriani</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>203</td>
<td></td>
<td>BIMALA SANJAYA MEGAH PT </td>
<td>Cabang</td>
<td>442/6426/101.5/2009 </td>
<td>Jl. Rungkut Mapan Tengah VIII/DG.16 Sura
baya</td>
<td>031-8704113</td>
<td>Marietta Angeline Dian Soeheningsih </td

>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>204</td>
<td></td>
<td>BINA ARTHA LESTARI UTAMA PT</td>
<td>Cabang</td>
<td>35087/PBF/VI/95</td>
<td>Jl. Wiguna timur XIII/1 Surabaya</td>
<td></td>
<td>Yulistyorini Dwi U </td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>205</td>
<td></td>
<td>BINA SAN PRIMA PT CAB.SBY I </td>
<td>Cabang</td>
<td>442/8957/101.5/2010</td>
<td>Jl. Raya Gubeng No. 16 Surabaya </td>
<td>Telp.031-503102425</td>
<td>Lena Wibiksana </td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>206</td>
<td></td>
<td>BINA SAN PRIMA PT CAB.SBY II</td>
<td>Cabang</td>
<td>32052/PBF/Cab-24/VII/02</td>
<td>Jl. Rungkut Industri III/22 Surabaya </t
d>
<td>Telp.8477151</td>
<td>Kwee Ing Kwan </td>
<td>L</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>207</td>
<td></td>
<td>BINA SARANA HUSADA MEDIKA PT</td>
<td>Pusat</td>
<td>952/Menkes/SK/VII/2003</td>
<td>Jl. USI VII / 3 Surabaya</td>
<td></td>
<td>Abdulah Halimi </td>
<td>L</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>208</td>
<td></td>
<td>BINTANG CENTRAL SAKTI PT</td>
<td>Pusat</td>
<td>HK.07.01/I/640/09</td>
<td>Jl. Kebonsari Baru 14
Surabaya </td
>
<td>(031) 8282505 </td>
<td>Sabarahwati </td>
<td>P</td>
<td>SIK No.503.446/0377/36776/ SIKAA/436.5.5
/VI/2009</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>209</td>
<td></td>
<td>BLESSINDO FARMA PT</td>
<td>Pusat</td>
<td>055.276/PBF.Pusat/13.01/I/2005</td>
<td>Jl. Mayjen Sungkono Komp.Wonokitri Indah
S-33 Sby (alamat baru) </td>
<td>5614975</td>
<td>Soendayati </td>
<td>P</td>
<td>5516/B</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>210</td>
<td></td>
<td>BORIMEX PT</td>
<td>Pusat</td>
<td>686/Menkes/SK/V/2003</td>
<td>Jl. Jagir Wonokromo 100 Komp. Mangga Dua
Blok A.10 No.1 Surabaya</td>
<td></td>
<td>Susy Handayani </td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>211</td>
<td></td>
<td>BORWITA INDAH PT</td>
<td>Cabang</td>
<td>35010/PBF/XII/1990 </td>
<td>Jl. Kunir No. 9 Surabaya</td>
<td></td>
<td>Like Suhermien </td>
<td>P</td>
<td>5369/B</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>212</td>
<td></td>
<td>BUKIT ARTA GUNA PT</td>
<td>Cabang</td>
<td>35187/PBF/II/02 </td>
<td>Komp Pertokooan Villa Bukit Mas Blok RM19Jl. H.Abdul Wahab Siamin Sby </td>
<td>Telp.5651113, 5651114</td>
<td>Endah S Murdiyanti 41962/Pend/AA</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>213</td>
<td></td>
<td>CAHAYA ANUGERAH PT</td>
<td>Pusat</td>
<td>Jl. Bintoro 11 Surabaya</td>
<td></td>
<td>Sri Handayani </td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>214</td>
<td></td>
<td>CATUR MANDIRI FARMA PT</td>
<td></td>
<td></td>
<td>Jl. Jemursari II/66 Surabaya</td>
<td></td>
<td>Endang Soebagijati </td>
<td>P</td>
<td>4885/B</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>215</td>
<td></td>
<td>CEMPAKA INDAH MURNI PT</td>
<td>Pusat</td>
<td>1215/Menkes/SK/VIII/2003</td>
<td>Jl. Gayungan PPN No.7 Surabaya </td>
<td>Telp. 8285254</td>
<td>Alociana Dominika </td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>216</td>
<td></td>
<td>CEMPAKA INDAH MURNI PT CABANG SURABAYA</
td>
<td>Cabang</td>
<td>013.1215//PBF/13.01/X/2003 </td>
<td>Jl. Bibis No. 14 Surabaya</td>
<td></td>
<td>Ema Herprasetiyati</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>217</td>
<td></td>
<td>CENDIKIA MULTI PRATAMA</td>
<td>Cabang</td>
<td>35113/PBF/XI/98 </td>
<td>Jl. Pucang Anom Timur No.34
Surabaya<
/td>
<td></td>
<td>Ninik Setyawati </td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>218</td>
<td></td>
<td>CENDO PRATAMA FARMA PT</td>
<td>Cabang</td>
<td>32005/PBF/I/1991 </td>
<td>Jl. Mayjen Sungkono Wonokitri Indah S/33
Surabaya</td>
<td></td>
<td>Ny. Soendayati</td>
<td>P</td>
<td> 5516/B</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>219</td>
<td></td>
<td>CITRA HUSADA MADANI PT</td>
<td>Pusat</td>
<td>Jl. Manyar Indah VII/12 Surabaya</td>
<td></td>
<td>E.L.Dwi Retno Wahyuni </td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>220</td>
<td></td>
<td>DALAN TRIPUTRA MANDIRI PT </td>
<td>Cabang</td>
<td>442/10181/101.5/2010 29-1-2010</td>
<td>Jl. Raya Kalirungkut 1-3 Blok N-12 Kompl
ek Ruko Megah Raya Surabaya </td>
<td>031-8791211</td>
<td>Yunita Irwanto, SFarm,Apt </td>
<td>P</td>
<td>KP.01.03.1.3.3380</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>221</td>
<td></td>
<td>DAYA ANUGRAH DEWATA PT DAYA ANUGRAH DEW
ATASAKTI PT</td>
<td>Cabang</td>
<td>35049/PBF/I/92</td>
<td>Jl. Taman Jemursari selatan I/7 Surabay
a</td>
<td></td>
<td>Hendy Prabowo</td>
<td>L</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>222</td>
<td></td>
<td>DEFINA RAHMAH PT</td>
<td></td>
<td></td>
<td>Jl. Wisma Lidah Kulon Blok C-76 Surabaya
</td>
<td></td>
<td>Tri Udjianto </td>
<td>L</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>223</td>
<td></td>
<td>DIAN CITRA HARAPAN PT</td>
<td>Cabang</td>
<td>35100/PBF/VII/97 032.35100/PBF.Pusat/13.
01/III/2004</td>
<td>Jl. Pucang Anom Timur IV/12 Sby</td>
<td> Telp. 5028881</td>
<td>Adi Wijaya Putra </td>
<td>L</td>
<td>503.446/0005/SIK.AA/436.4.8/IV/2004</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>224</td>
<td></td>
<td>DISTRIVERSA BUANAMAS CAB SURABAYA PT</td
>
<td>Cabang</td>
<td>34.32030/PBF.Cab/13.01/XI/2007</td>
<td>Jl. Margorejo Indah No. 28 Surabaya</td>
<td></td>
<td>Theresia Jeannie N </td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2011</td>
</tr>
<tr>
<td>225</td>
<td>KAB. BANGKALAN</td>
<td></td>
<td>PT. Lembu Suro</td>
<td>Pusat</td>
<td></td>
<td>Jl. Nangka Raya No. 11, Kamal, Bangkalan
</td>
<td></td>
<td>Ani Ultralindaningtyas</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>226</td>
<td></td>
<td>PT. Andika Intisurya Kusuma Farma</td>
<td>Pusat</td>
<td></td>
<td>Dsn. Krajan RT/RW 01/05, Sukonator, Kec.
Srono, Banyuwangi</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>227</td>
<td></td>
<td>PT. Sumber Gondo Perkasa</td>
<td>Pusat</td>
<td></td>
<td>Jl. Raya Jember Stail No. 87, Genteng, B
anyuwangi</td>
<td></td>
<td>Yeni Sintia Dewi</td>
<td>P</td>
<td>0501.896AA</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>228</td>
<td></td>
<td>PT. Andhi Cipta Jaya Utama</td>
<td>Pusat</td>
<td></td>
<td>Jl. Brawijaya No. 12 A, Banyuwangi</td>
<td></td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>229</td>
<td></td>
<td>PT. Kapas Makmur Sentosa</td>
<td>Pusat</td>
<td></td>
<td>Jl. Raya Kapas No. 53, Bojonegoro</td>
<td></td>
<td>Juliati</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>230</td>
<td></td>
<td>PT. Mawar Abadi Pharmindo</td>
<td>Pusat</td>
<td></td>
<td>Jl. Letjend. Soeprapto No. 81, Bondowoso
</td>
<td></td>
<td>Melisa, S. Farm, Apt</td>
<td>P</td>
<td>SP. Kp. 01,03,1,3,4044</td>
<td></td>
<td>NINIK</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>231</td>
<td></td>
<td>PT. Safari Jaya Abadi</td>
<td>Pusat</td>
<td></td>
<td>Jl. KH. Zainul Arifin No. 1, Bondowoso</
td>
<td></td>
<td>Inggriany Gunawan , S.Si, Apt</td>
<td>P</td>
<td>SP. KP. 01.03.1.3.5912</td>
<td></td>
<td>HENI RAHMAWATI,S.Pd</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>232</td>
<td></td>
<td>PT. Teguh Karya Raharjdo</td>
<td>Pusat</td>
<td></td>
<td>Jl. A.Yani No. 8-10, Bondowoso</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>233</td>
<td></td>
<td>PT. Mitra Abadi Parmindo</td>
<td>Pusat</td>
<td></td>
<td>Perum Taman Sari Indah Blok J 8-9, Bondo
woso</td>
<td></td>
<td>Siti Rumaikah</td>
<td>P</td>
<td>02/SIK.AAIV/2006</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>234</td>
<td></td>
<td>PT. Bintang Pramesti Utama</td>
<td>Pusat</td>
<td></td>
<td>Jl. Kalimantan 48 Kav 51, Gresik
<td></td>
<td>Solikha </td>
<td>P</td>
<td>SIK 446/949/437.52/2009</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
</td>
<tr>
<td>235</td>
<td></td>
<td>PT. Rajawali Nusindo</td>
<td>Cabang</td>
<td></td>
<td>Jl. Usman Sadar No. 36, Gresik</td>
<td></td>
<td>Agustina Eka Puspitasari,Sfarm,Apt</td>
<td>P</td>
<td>KP.01.03.1.3.0120</td>
<td></td>
<td>Ahmad Yohanes</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>236</td>
<td></td>
<td>PT. Antar Mitra Sembada</td>
<td>Cabang</td>
<td></td>
<td>Jl. Nusantara III Blok C-25, Jember</td>
<td></td>
<td>Sri Wahyuni</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>237</td>
<td></td>
<td>PT. Anugrah Argon Medica</td>
<td>Cabang</td>
<td></td>
<td>Jl. Teuku Umar No. 72, Jember</td>
<td></td>
<td>Ach. Riyadi, S.Farm., Apt</td>
<td>L</td>
<td>19840706/STRA-USB/2010/16726</td>
<td></td>
<td>Ambar Santoso</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>238</td>
<td></td>
<td>PT. Anugrah Pharmindo Lestari</td>
<td>Cabang</td>
<td></td>
<td>Jl. Letjen Sutoyo No. 138, Kel Kranjinga
n, Kec. Sumbersari, Jember</td>
<td></td>
<td>Dian Anggraini,S.Farm.,Apt</td>
<td>P</td>
<td>19850303/STRA-UII/2011/26258</td>
<td></td>
<td>Asaato Telaumbanua,Bc</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>239</td>
<td></td>
<td>PT. Bina San Prima</td>
<td>Cabang</td>
<td></td>
<td>Jl. Letjen Sutoyo No. 138, Jember</td>
<td></td>
<td>Ika Nursiana,S.Farm.,Apt</td>
<td>P</td>
<td>19850505/STRA-UGM/2010/221339</td>
<td></td>
<td>Suyanta</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>240</td>
<td></td>
<td>PT. Borsumij Wehry Indonesia</td>
<td>Cabang</td>
<td></td>
<td>Jl. PB. Sudirman, Jember</td>
<td></td>
<td>Ana Sukma Lestari</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>241</td>
<td></td>
<td>PT. Dos Ni Roha</td>
<td>Cabang</td>
<td></td>
<td>Jl. Sentot Prawirodirjo No. 42, Jember</
td>
<td></td>
<td>Khoiriyatul Muhlishoh Arwi, S.Farm., Apt
</td>
<td>P</td>
<td>19850223/STRA-USB/2011/22460</td>
<td></td>
<td>Ida Bagus Putu Nuaba</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>242</td>
<td></td>
<td>PT. Enseval Putera Megatrading Tbk</td>
<td>Cabang</td>
<td></td>
<td>Jl. Wolter Monginsidi No. 889, Rowo Inda
h Ajung, Jember</td>
<td></td>
<td>Fahmi Ulfi, S.Farm., Apt</td>
<td>L</td>
<td>19870704/STRA-UNUD/2011/12796</td>
<td></td>
<td>Benny Pramono Sudjatmiko</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>243</td>
<td></td>
<td>PT. Farmahusada Millenia</td>
<td>Pusat</td>
<td></td>
<td>Jl. Srikoyo I/7, Jember</td>
<td></td>
<td>Andri Astuti, S.Farm., Apt</td>
<td>P</td>
<td>19801010/STRA-UNAIR/2007/214911</td>
<td></td>
<td>Udi</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>244</td>
<td></td>
<td>PT. Indofarma Husada Sehat</td>
<td>Pusat</td>
<td></td>
<td>Jl. Karimata IV/20, Jember</td>
<td></td>
<td>Inge Maeeinda Prihartini</td>
<td>P</td>
<td>440/011/436.317/2006</td>
<td></td>
<td>Ir. Mahfudi Husodo</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>245</td>
<td></td>
<td>PT. Indorukma Setiajaya</td>
<td>Pusat</td>
<td></td>
<td>Jl. Samanhudi No. 88 A, Jember </td>
<td></td>
<td>Dedy Prishatowo</td>
<td>L</td>
<td></td>
<td>Setawan</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>246</td>
<td></td>
<td>PT. Kebayoran Farma</td>
<td>Cabang</td>
<td></td>
<td>Jl. Nusantara V/12A Blok C, Jember</td>
<td></td>
<td>Eko Novianto Rahayu</td>
<td>L</td>
<td>111.6/13/SIAA/331/01098/V/08</td>
<td></td>
<td>Irzam Zani Mura,SE</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>247</td>
<td></td>
<td>PT. Koperasi Karyawan Alamanda</td>
<td>Pusat</td>
<td></td>
<td>Jl. Citarum No. 21, Jember</td>
<td></td>
<td>Yulis Wulandari</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>248</td>
<td></td>
<td>PT. Lizmulti Usaha</td>
<td>Pusat</td>
<td></td>
<td>Jl. Arowana No. 69, Jember</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>249</td>
<td></td>
<td>PT. Masamedi Inti Farmindo</td>
<td>Pusat</td>
<td></td>
<td>Jl. Sutoyo No. 45, Jember</td>
<td></td>
<td>Fitriyah</td>
<td>P</td>
<td>440/152/436.317/VII/2008</td>
<td></td>
<td>Sutarno</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>250</td>
<td></td>
<td>PT. Merapi Utama Pharma </td>
<td>Cabang</td>
<td></td>
<td></td>
<td>Ade Zona Akhirita Junjungan, S.Farm.,Apt
</td>
<td>L</td>
<td>19861226/STRA-UNAIR/2010/221399</td>
<td></td>
<td>Daniel D. Mitak</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>251</td>
<td></td>
<td>PT. Millennium Pharmacon International</
td>
<td>Cabang</td>
<td></td>
<td>Jl. Kertanegara No. 210, Jember</td>
<td></td>
<td>Dewi Rahmawati, S.Farm., Apt</td>
<td>P</td>
<td>19870408/STRA-UMS/2009/221348</td>
<td></td>
<td>Suwoto</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>252</td>
<td></td>
<td>PT. Mitra Pharmindo Sejati</td>
<td>Pusat</td>
<td></td>
<td>Jl. Kertanegara 165/25, Jember</td>
<td></td>
<td>Heni Fajar Suryawati</td>
<td>P</td>
<td>0501822.AA</td>
<td></td>
<td>Mochammad Rosul</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>253</td>
<td></td>
<td>PT. Omni Megajasa Indoprima</td>
<td>Pusat</td>
<td></td>
<td>Jl. Wolter Monginsidi No. 60/99, Jember<
/td>
<td></td>
<td>Ester Tieneke</td>
<td>P</td>
<td>6719/B</td>
<td></td>
<td>Hendricus Fianto</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>254</td>
<td></td>
<td>PT. Penta Valent</td>
<td>Cabang</td>
<td></td>
<td>Jl. Imam Bonjol 6, Kaliwates, Jember</td
>
<td></td>
<td>Febrian Wahyu Mushonnifa S,Farm.Apt</td>
<td>L</td>
<td>19860210/STRA-UNAIR/2010/224425</td>
<td></td>
<td>Edy Supriyana</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>255</td>
<td></td>
<td>PT. Pharmindo Rimpang Kokoh</td>
<td>Cabang</td>
<td></td>
<td></td>
<td>MaeAtul Hasanah</td>
<td>P</td>
<td>440/016/436.317/2005</td>
<td></td>
<td>Djoko Prasetyo</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>256</td>
<td></td>
<td>PT. Rejeki Mitra Farma</td>
<td>Cabang</td>
<td></td>
<td>Jl. Hayam Wuruk No. 191, Jember</td>
<td></td>
<td>Vega Evaliene Pratiwi</td>
<td>P</td>
<td>440/018/436.317/2006</td>
<td></td>
<td>Samuel Iskandar </td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>257</td>
<td></td>
<td>PT. Sahabat Insan Medika </td>
<td>Pusat</td>
<td></td>
<td>Jl. Sumatera No. 119, Jember</td>
<td></td>
<td>Lindiawati Dwi A</td>
<td>P</td>
<td>0501871.AA</td>
<td></td>
<td>Dree Rhomaniyani</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>258</td>
<td></td>
<td>PT. Sapta Sari Tama</td>
<td>Cabang</td>
<td></td>
<td></td>
<td>Faridha Ariastuti</td>
<td>P</td>
<td></td>
<td>Drs. A. Sri Mulyo S</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>259</td>
<td></td>
<td>PT. Tempo</td>
<td>Cabang</td>
<td></td>
<td></td>
<td>Dian Mayasari, S.Farm.,Apt</td>
<td>P</td>
<td>KP.01.01.1.3.0285</td>
<td></td>
<td>Mochammad HasmiAzhari</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>260</td>
<td></td>
<td>PT. Perusahaan Perdagangan Indonesia</td
>
<td>Cabang</td>
<td></td>
<td>Jl. PB Sudirman No. 71, Jember</td>
<td></td>
<td>Siti Rochaya</td>
<td>P</td>
<td></td>
<td>Drs. I. Nyoman Yasa</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>261</td>
<td></td>
<td>PT. Supra Usadhatama</td>
<td>Cabang</td>
<td></td>
<td>Jl. Teuku Umar No. 87, Tegal Besar, Kali
wates, Jember</td>
<td></td>
<td>Ummul Mursidah, S.Farm.,Apt</td>
<td>P</td>
<td>19870905/SIKA_35.09/2011/2001</td>
<td></td>
<td>Sugiantoro</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>262</td>
<td></td>
<td>Cabang</td>
<td></td>
<td>Jl. Tawang Mangu No. 131 A, Jember</td>
<td></td>
<td>Rio Dedi Pranoto S.Farm., Apt</td>
<td>L</td>
<td>19870114/STRA-UNUD/2011/11242</td>
<td></td>
<td>Soepono, SE</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>263</td>
<td></td>
<td>PT. Sakajaja Makmur Abadi</td>
<td>Cabang</td>
<td></td>
<td>Jl. Mojopahit Blok Y No. 8, Kaliwates, J
ember</td>
<td></td>
<td>Widya Ari Sukmawati, S.Farm., Apt</td>
<td>P</td>
<td>19850111/SIK-35.09/2011/2002</td>
<td></td>
<td>Tri Murtiningsih</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>264</td>
<td></td>
<td>PT. Sumber Baru Megafarma</td>
<td>Pusat</td>
<td></td>
<td>Jl. M. Yamin No. 69, Jember</td>
<td></td>
<td>Amelia Setiarini,Ssi,Apt</td>
<td>P</td>
<td>KP.01.03.1.3.1106</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>265</td>
<td></td>
<td>PT. Mensa Bina Sukses</td>
<td>Cabang</td>
<td></td>
<td>Jl. K.H.Shiddiq No. 110, Jember</td>
<td></td>
<td>Farroh Hayatinnufus Syafira, S.Farm., Ap
t</td>
<td>P</td>
<td>19890224/STRA-ITB/2011/26538</td>
<td></td>
<td>Pamuji</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>266</td>
<td></td>
<td>PT. Atmosfer Khatulistiwa Pratama</td>
<td>Pusat</td>
<td></td>
<td>Perum Bumi Tegal Besar Blok AA-8, Jember
</td>
<td></td>
<td>Aisyah Rohmatullah, S.Farm., Apt</td>
<td>P</td>
<td>19880616/STRA-UNAIR/2012/225596</td>
<td></td>
<td>Muhammad Asyhari Bungah</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>267</td>
<td></td>
<td>PT. Marga Nusantara Jaya</td>
<td>Cabang</td>
<td></td>
td>
<td></td>
<td>Ike Nur Fitriana, S.Farm., Apt</td>

<td>P</td>
<td>19890507/STRA-UNAIR/2011/24014</td>
<td></td>
<td>Drs. Tri Hadi Mulyono</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>268</td>
<td></td>
<td>PT. Sakajaja Makmur Abadi </td>
<td>Cabang</td>
<td></td>
<td>Jl. Yos Sudarso No. 48 B, Jombang</td>
<td></td>
<td>Victa Elshera Pradana, S.Farm.Apt</td>
<td>P</td>
<td>KP. 01.03.1.3.3245</td>
<td></td>
<td>Sutadji</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>269</td>
<td></td>
<td>PT. Cipta Prakarsa Jaya</td>
<td>Pusat</td>
<td></td>
<td>Selatan Pabrik Gula No. 91, Cukirdiwek,
Jombang</td>
<td></td>
<td>Sri Ambarwati</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>270</td>
<td></td>
<td>Cabang</td>
<td></td>
<td>Jl. Mayor Bismo No. 229, Kediri</td>
<td></td>
<td>Eko Siswanto, S.Farm., Apt</td>
<td>L</td>
<td>19870526/STRA-USB/2011/10572</td>
<td></td>
<td>Chusnul Yakin</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>271</td>
<td></td>
<td>PT. Tempo</td>
<td>Cabang</td>
<td></td>
<td>Jl. Mataram No. 176, Kediri</td>
<td></td>
<td>Dina Mariani.Sfarm,Apt</td>
<td>P</td>
<td>KP.01.03.1.3.3748</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>272</td>
<td>KAB. MADIUN</td>
<td></td>
<td>Cabang</td>
<td></td>
<td>Jl. Raya Tiron No. 64, Nglames, Madiun</
td>
<td></td>
<td>Lanawati</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>273</td>
<td></td>
<td>Cabang</td>
<td></td>
<td>Jl. Raya Solo 5B, Kav. 4 RT/RW 18/06, Kw
angsen Jiwan, Madiun</td>
<td></td>
<td>Ruly Jayanti, S.Farm., Apt</td>
<td>P</td>
<td>KP.01.03.1.3.3343</td>
<td></td>
<td>Imam Triono</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>274</td>
<td></td>
<td>Cabang</td>
<td></td>
<td>Jl. Raya Ponorogo No.11, Madiun</td>
<td></td>
<td>Ainul Rodiyah Ssi,Apt.</td>
<td>P</td>
<td>KP.01.01.1.3.6546</td>
<td></td>
<td>Nanang Arfianto</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>275</td>
<td></td>
<td>Cabang</td>
<td></td>
<td>Jl. Raya Solo No. 154, Jiwan, Madiun</td
>
<td></td>
<td>Sri Prihatiningsih, S.Farm., Apt</td>
<td>P</td>
<td>19870312/STRA-USB/2011/22509</td>
<td></td>
<td>Sugianto Sanjaya</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>276</td>
<td>KAB. MAGETAN</td>
<td></td>
<td>PT. Akbar Jaya Farma</td>
<td>Pusat</td>
<td></td>
<td>Ds. Manjung RT/RW 01/01, Magetan</td>
<td></td>
<td>Yetti Hariningsih, S.Farm., Apt</td>
<td>P</td>
<td>19790119/STRA-USB/2004/220592</td>
<td></td>
<td>Kardjo</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>277</td>
<td>KAB. MALANG</td>
<td></td>
<td>Cabang</td>
<td></td>
<td>Jl. Industri No.90, Mangliawan Pakis, Ma
lang</td>
<td></td>
<td>Hendra Tri Pramono,S.Farm,Apt</td>
<td>L</td>
<td>19840417/STRA-USD/2008/11403</td>
<td></td>
<td>Fransiscus Sutarsono</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>278</td>
<td></td>
<td>Cabang</td>
<td></td>
<td>Jl. Mondoroko No. 169 A, Pagentan, Singo
sari, Malang</td>
<td></td>
<td>Dyah Suci Nurani,S.Farm,Apt</td>
<td>P</td>
<td>19870122/STRA-UNUD/2011/24808</td>
<td></td>
<td>Frangky Pramono</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>279</td>
<td></td>
<td>PT. Nusa Sari Pharma</td>
<td>Pusat</td>
<td></td>
<td>Jl. Anusopati No. 59, Singosari, Malang<
/td>
<td></td>
<td>Rani Mumpuni Rahayu,S.Farm,Apt</td>
<td>P</td>
<td>19880501/SIPA_35.07/2011/2003</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>280</td>
<td></td>
<td>PT. Tri Sapta Jaya</td>
<td>Cabang</td>
<td></td>
<td>Jl. Raya Karanglo No.73, Singosari, Mala
ng</td>
<td></td>
<td>Fanny Suryana,S.Farm,Apt</td>
<td>P</td>
<td>KP.01.03.1.3.6132</td>
<td></td>
<td>Sutrisno</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>281</td>
<td></td>
<td>PT. Mega Karya Indonesia Jaya</td>
<td>Pusat</td>
<td></td>
<td>Perum Nyalabu Indah Blok D No. 1, Pameka

san</td>
<td></td>
<td>Novi Hidayati</td>
<td>P</td>
<td></td>
<td>Ir. Agus Kasiyanto, SH.,MH.</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>282</td>
<td>KAB. PASURUAN</td>
<td></td>
<td>PT. Sejahtera Lestari </td>
<td>Pusat</td>
<td></td>
<td>Ds. Talun No.1, Gunung Gangsir, Beji, Pa
suruan</td>
<td></td>
<td>Agnes R. Q., S.Si.Apt.</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>283</td>
<td></td>
<td>PT. Seles Global Farma</td>
<td>Pusat</td>
<td></td>
<td>Dsn Talun 03/03, Desa Gunung Gangsil, Pa
suruan</td>
<td></td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>284</td>
<td></td>
<td>PT. Mentari Indah Permai</td>
<td>Pusat</td>
<td></td>
<td>Jl. Janoko No. 53, Ponorogo</td>
<td></td>
<td>Umi MarAtul Sholichah</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>285</td>
<td></td>
<td>PT. Cahaya Meyza Putra Sentosa</td>
<td>Pusat</td>
<td></td>
<td>Jl. Cindewilis No. 2 A, Ponorogo</td>
<td></td>
<td>Dewi Anggraeni, S.Farm., Apt</td>
<td>P</td>
<td>19871114/STRA-UII/2011/26255</td>
<td></td>
<td>Merry Yussnita, S.Si., Apt</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>286</td>
<td></td>
<td>PT. Andhika Mitra Serasi</td>
<td>Pusat</td>
<td></td>
<td>Ruko Pondok ChandraJl. Palem ITC-15, Si
doarjo</td>
<td></td>
<td>Kariyati</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>287</td>
<td></td>
<td>PT. Abirawa Setia Sejahtera</td>
<td>Pusat</td>
<td></td>
<td>Delta Sari Indah AX-14, Sidoarjo</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>288</td>
<td></td>
<td>PT. Alamanda Medica Farma</td>
<td>Pusat</td>
<td></td>
<td>Jl. Jatisari Permai I/D4, Wisma Permai B
ungurasih, Waru, Sidoarjo</td>
<td></td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>289</td>
<td></td>
<td>PT. Bangkit Husada Farma</td>
<td>Pusat</td>
<td></td>
<td>Jl. Delta Sari Indah BE-17, Sidoarjo</td
>
<td></td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>290</td>
<td></td>
<td>PT. Bina Mitra Jaya Bersama</td>
<td>Pusat</td>
<td></td>
<td>Ruko Gateway A 36-37, Sidoarjo</td>
<td></td>
<td>Eko Purwanto</td>
<td>L</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>291</td>
<td></td>
<td>PT. Bintang Fajar Jaya Bersama</td>
<td>Pusat</td>
<td></td>
<td>Perum Permata Sukodono Raya Blok C-1 No.
34, Sidoarjo</td>
<td></td>
<td>Arie Widyani</td>
<td>P</td>
<td></td>
<td></td>
<td>Mujito</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>292</td>
<td></td>
<td>PT. Borsumij Wehry Indonesia</td>
<td>Cabang</td>
<td></td>
<td>Jl. Raya Waru No. 44, Waru, Sidoarjo</td
>
<td></td>
<td>L</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>293</td>
<td></td>
<td>PT. Borwita Citra Prima</td>
<td>Pusat</td>
<td></td>
<td>Jl. Raya Taman No. 48 A, Taman, Sidoarjo
</td>
<td></td>
<td>Shierly Regina P</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>294</td>
<td></td>
<td>PT. Buwana Nugroho Lestari</td>
<td>Pusat</td>
<td></td>
<td>Perum Magersari Permai Blok J-12, Sidoar
jo</td>
<td></td>
<td>L</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>295</td>
<td></td>
<td>PT. Citra Mandiri Farmatama</td>
<td>Cabang</td>
<td></td>
<td>Jl. Jeruk VI/5, Sidoarjo</td>
<td></td>
<td>Djamilah</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>296</td>
<td></td>
<td>PT. Daya Muda Agung</td>
<td>Cabang</td>
<td></td>
<td>Jl. Nangka No. 265, Desa Sruni Gedangan<
/td>
<td></td>
<td>Nita Purnamawati, S.Farm., Apt</td>
<td>P</td>
<td>KP.01.03.1.3.2574</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>297</td>
<td></td>
<td>PT. Delta Intan Mandiri</td>
<td>Pusat</td>
<td></td>
<td>Jl. Delta Puspa No. 147, Waru, Sidoarjo<
/td>
<td></td>
<td>Erwina Kurniawati, S.Farm, Apt</td>
<td>P</td>
<td></td>
<td></td>
<td>Mochamad Asmanu</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>298</td>
<td></td>
<td>PT. Dempo Sentosa</td>
<td>Pusat</td>
<td></td>
<td>Kompleks Gudang West Gate B-19, Gedangan
, Sidoarjo</td>
<td></td>
<td>Arief Panji S</td>
<td>L</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>299</td>
<td></td>
<td>PT. Dua Sekawan Sejahtera</td>
<td>Pusat</td>
<td></td>
<td>Perum Pondok Jati II Blok A/28, Sidoarjo
</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>300</td>
<td></td>
<td>PT. Enseval Putra Megatrading Tbk</td>
<td>Cabang</td>
<td></td>
<td>Jl. Berbek Industri VII No. 8-10, Sidoar
jo</td>
<td></td>
<td>Fatimatus Zahroh, S.Farm., Apt</td>
<td>P</td>
<td>KP.01.03.1.3.3766</td>
<td></td>
<td>Sinyo.M.Kolinug</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>301</td>
<td></td>
<td>PT. Fitalab Utama Karya</td>
<td>Cabang</td>
<td></td>
<td>Jl. A.Yani No. 41-43. Kompleks Pergudang
an Central Square Blok E 5, Gedangan, Sidoarjo</td>
<td></td>
<td>P</td>
<td>42017/pend/AA</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>302</td>
<td></td>
<td>PT. Forta Mitra Sejati</td>
<td>Cabang</td>
<td></td>
<td>Jl. Raya Wisma Tropodo AC-8, Sidoarjo</t
d>
<td></td>
<td>Sarimurti Dewi A</td>
<td>P</td>
<td>442/III.5/5023B/2003</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>303</td>
<td></td>
<td>PT. Gatra Persada</td>
<td>Pusat</td>
<td></td>
<td>Jl. Sambisari Kav. Utara Blok F No. 6,Ta
man, Sidoarjo</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>304</td>
<td></td>
<td>PT. Indositra Utama</td>
<td>Pusat</td>
<td></td>
<td>Perum Taman Pondok Jati Blok AY No. 6, S
idoarjo</td>
<td></td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>305</td>
<td></td>
<td>PT. Insan Indofarma</td>
<td>Pusat</td>
<td></td>
<td>Kompleks Industri dan Pergudangan Sinar
Buduran Blok A Kav No. 3, Buduran, Sidoarjo</td>
<td></td>
<td>Diky Erdiyono S.Farm., Apt</td>
<td>L</td>
<td></td>
<td></td>
<td>Djonny Taslim</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>306</td>
<td></td>
<td>PT. Kanigoro Indah Perkasa</td>
<td>Pusat</td>
<td></td>
<td>Pertokoan Taman Jenggolo Mas Blok B-15Jl
. Sunandar Priyo Sudarmo, Sidoarjo</td>
<td></td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>307</td>
<td></td>
<td>PT. Kimia Farma Trading & Distribution</
td>
<td>Cabang</td>
<td></td>
e C No.9, Seruni Gedangan, Sidoarjo</td>
<td></td>
<td>Rudi Syahrial, S.Farm., Apt</td>
<td>L</td>
<td>KP.01.03.1.3.3636</td>
<td></td>
<td>Andi Prazos</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>308</td>
<td></td>
<td>PT. Lelela Bhakti Utama</td>
<td>Pusat</td>
<td></td>
<td>Ruko Deltasari Indah AN/8, Sidoarjo</td>
<td></td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>309</td>
<td></td>
<td>PT. Maxindo Health Perkasa</td>
<td>Pusat</td>
<td></td>
<td>Jl. Raya Sedati Agung No. 27, Sidoarjo</
td>
<td></td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>310</td>
<td></td>
<td>PT. Medinarofa Karya Yasa</td>
<td>Pusat</td>
<td></td>
<td>Jl. Nakula E-12, Griya Sedati Indah, Sid
oarjo</td>
<td></td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>311</td>
<td></td>
<td>PT. Merapi Utama Pharma</td>
<td>Cabang</td>
<td></td>
<td>Jl. Raya Waru 1 A, Kompleks Pergudangan
Nila Alam 10, Sidoarjo</td>
<td></td>
<td>I.Gusti Ayu Prasanthy Suweda,Sfarm,Apt</
td>
<td>P</td>
<td>19851024/DTRA-UBAYA/2009/219060</td>
<td></td>
<td>Handoko Saputro</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>312</td>
<td></td>
<td>PT. Nusasari Dinamika</td>
<td>Pusat</td>
<td></td>
<td>Ruko Kedungturi Blok A-4,Jl. Kedungturi
No. 33, Sepanjang, Sidoarjo</td>
<td></td>
<td>Dewi Indria Safitri</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>313</td>
<td></td>
<td>PT. Osadha Graha Sejahtera</td>
<td>Cabang</td>
<td></td>
<td>Ruko Tanrise Central Square Blok C-12,Jl
. A.Yani, Gedangan, Sidoarjo</td>
<td></td>
<td>Crissta Dewi Linandarwati</td>
<td>P</td>
<td>19871119/STRA-UMS/2011/28601</td>
<td></td>
<td>Agus Sutejo</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>314</td>
<td></td>
<td>Cabang</td>
<td></td>
<td>Jl. Berbek Industri V/8, Waru, Sidoarjo<
/td>
<td></td>
<td>Trias Putro Wibowo, S.Farm., Apt</td>
<td>L</td>
<td>19860515/STRA-UNAIR/2010/15391</td>
<td></td>
<td>Sarwono</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>315</td>
<td></td>
<td>PT. Perdana Anugrah Sejahtera</td>
<td>Pusat</td>
<td></td>
<td>Jl. Delta Raya Selatan No. 45 (Deltasari
Baru), Sidoarjo</td>
<td></td>
<td>P</td>
<td>0501.831.AA</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>316</td>
<td></td>
<td>PT. Permata Delta Agung</td>
<td>Pusat</td>
<td></td>
<td>Perum Pesona Permata Gading C-14, Sidoar
jo</td>
<td></td>
<td>Didit Eka Permana S.Farm., Apt</td>
<td>L</td>
<td>19860627/STRA-UNAIR/2011/11008</td>
<td></td>
<td>Agung Kurniawan</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>317</td>
<td></td>
<td>Cabang</td>
<td></td>
<td>Jl. Raya Buncitan No. 1A, Sedati Juanda,
Sidoarjo</td>
<td></td>
<td>Dyah Pramanasari</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>318</td>
<td></td>
<td>Cabang</td>
<td></td>
<td>Jl. Raya Waru, Pertokoan Gateway Blok F
No. 10-12, Sidoarjo</td>
<td></td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>319</td>
<td></td>
<td>PT. Richtji</td>
<td>Cabang</td>
<td></td>
<td>Jl. Nanas VII No. 679, Pondok Candra, Si
doarjo</td>
<td></td>
<td>P</td>
<td>0502.1733.AA</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>320</td>
<td></td>
<td>PT. San Prima Sejati</td>
<td>Cabang</td>
<td></td>
<td>Jl. Rajawali No. 31, Rewin, Waru, Sidoar
jo</td>
<td></td>
<td>Ayu Menik Ariyanti, S.Si., Apt</td>
<td>P</td>
<td>19790619/STRA-UNAIR/2004/227367</td>
<td></td>
<td>Mochamad Munief</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>321</td>
<td></td>
<td>PT. Sativa Graha Farma</td>
<td>Pusat</td>
<td></td>
<td>Jl. Blimbing II No. 83, Pondok Candra, S
idoarjo</td>
<td></td>
<td>Octavian Hari Susanto, S.Si., Apt</td>
<td>L</td>
<td>KP.01.01.3.02558</td>
<td></td>
<td>Dra. Sufaria</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>322</td>
<td></td>
<td>PT. Sedati Gunung Mulia</td>
<td>Pusat</td>
<td></td>
<td>Kompleks Pergudangan Maiko Abadi Blok A23, Wedi Gedangan, Sidoarjo</td>
<td></td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>323</td>
<td></td>
<td>PT. Sinar Niaga Sejahtera</td>
<td>Pusat</td>
<td></td>
<td>Jl. Ngelom Megare No. 573, Sidoarjo</td>
<td></td>
<td>Rachmawati Fitria</td>
<td>P</td>
<td>503.445/0158/SIKAA/436.5.5/VI/2006</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>324</td>
<td></td>
<td>PT. Solaris Multi Abadi</td>
<td>Pusat</td>
<td></td>
<td>Kompleks Pergudangan West Gade Diamond B
lok B-9, Wedi Gedangan, Sidoarjo</td>
<td></td>
<td>Erlena Jauwri, S,Farm.Apt</td>
<td>P</td>
<td>KP.01.03.1.3.4363</td>
<td></td>
<td>Pawit</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>325</td>
<td></td>
<td>PT. Sun Hodos</td>

<td>Pusat</td>
<td></td>
<td>Jl. Taruna No. 217, Wage, Sidoarjo</td>
<td></td>
<td>Wahyu Aji, S.Farm., Apt</td>
<td>L</td>
<td>19860705/STRA-UMS/2010/15497</td>
<td></td>
<td>Setiabudi, ST</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>326</td>
<td></td>
<td>PT. Tiara Rucita Pharmindo</td>
<td>Pusat</td>
<td></td>
<td>Ruko Taman Aloha No. 6 (Lantai 2)</td>
<td></td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>327</td>
<td></td>
<td>PT. Tri Sapta Jaya</td>
<td>Cabang</td>
<td></td>
<td>Ruko Gateway Blok F No. 10-12, Sidoarjo<
/td>
<td></td>
<td>Nur Madusari,Sfarm.Apt</td>
<td>P</td>
<td>KP01.03.1.3.1742</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>328</td>
<td></td>
<td>PT. Kebayoran Pharma</td>
<td>Cabang</td>
<td></td>
<td>Jl. Palm 2 Blok TD No. 23, Pondok Candra
Indah, Sidoarjo</td>
<td></td>
<td>Ambarini Indah Puji Lestari, S.Farm., Ap
t</td>
<td>P</td>
<td>1988110/STRA-UNAIR/2011/24048</td>
<td></td>
<td>Saiful Arif</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>329</td>
<td></td>
<td>PT. Bintang Utama Inti Medika</td>
<td>Pusat</td>
<td></td>
<td>Ruko Sentra Tropodo C-25, Raya Tropodo N
o. 115, Sidoarjo</td>
<td></td>
<td>Sahetapy Maretia Tenesia Horas, S.Farm.,
Apt</td>
<td>P</td>
<td>KP.01.03.1.3.4081</td>
<td></td>
<td>Yuni Mindarti</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>330</td>
<td></td>
<td>PT. Prasetyo Pratama Jaya</td>
<td>Pusat</td>
<td></td>
<td>Jl. Raya Kotim Besuki, Situbondo</td>
<td></td>
<td>Yanuh Resmalaningrum</td>
<td>P</td>
<td>440/832/431.201.2.2/2006</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>331</td>
<td></td>
<td>PT. Papan Sehat Sejahtera</td>
<td>Pusat</td>
<td></td>
<td>Kampung Sabrang No. 9 RT/RW 02/01, Wring
inanom, Panarukan, Situbondo</td>
<td></td>
<td>Novianti Khodaniah</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>332</td>
<td></td>
<td>PT. Gentha Berlian</td>
<td>Pusat</td>
<td></td>
<td>Jl. Masalembu III/, Sumenep</td>
<td></td>
<td>Eko Kristanto, S.Farm., Apt</td>
<td>L</td>
<td>19870516/STRA-UNAIR/2010/17514</td>
<td></td>
<td>Drs. Abdurrachmad Amar</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>333</td>
<td></td>
<td>PT. Dana Utama</td>
<td>Pusat</td>
<td></td>
<td>Jl. Dr.Wahidin No. 47-49, Sumenep</td>
<td></td>
<td>SaIya</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>334</td>
<td></td>
<td>PT. Gentha Raya</td>
<td>Pusat</td>
<td></td>
<td>Jl. Slamet Riadi No. 9, Pabian, Sumenep<
/td>
<td></td>
<td>Nur Komariah, S.Farm., Apt</td>
<td>P</td>
<td>19870205/STRA-UNAIR/2011/214672</td>
<td></td>
<td>Moh. Saleh</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>335</td>
<td>KAB. TUBAN</td>
<td></td>
<td>PT. Sumber Dwi Jaya</td>
<td>Pusat</td>
<td></td>
<td>Jl. Ikan Kakap No. 5, Tuban</td>
<td></td>
<td>Maimunah</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>336</td>
<td></td>
<td>PT. Sinergi Distribusi Utama</td>
<td>Pusat</td>
<td></td>
<td>Jl. Moh. Yamin No. 108, Tulungagung</td>
<td></td>
<td>Esti Rahayuningsih, S.Farm, Apt</td>
<td>P</td>
<td></td>
<td>Hariadi</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>337</td>
<td></td>
<td>PT. Agung Yasa Husada</td>
<td>Pusat</td>
<td></td>
<td>Jl. Teuku Umar No. 88, Tulungagung</td>
<td></td>
<td>Ismiati, Amd</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>338</td>
<td></td>
<td>Pusat</td>
<td></td>
<td>Jl. K.H. Agus Salim 11 Blok A 24-25, Tul
ungagung</td>
<td></td>
<td>Wiwin Widyawati</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>339</td>
<td>KOTA BATU</td>
<td></td>
<td>PT. Indokarya Asifa</td>
<td>Pusat</td>
<td></td>
<td>Jl. Raya Sumbergondo No. 1 RT/RW 02/01,
Ds. Sumbergondo, Kec. Bumiaji, Batu</td>
<td></td>
<td>P</td>
<td></td>
<td>Isfahani, S.H</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>340</td>
<td>KOTA BATU</td>
<td></td>
<td>PT. Masrose Citra Abadi</td>
<td>Pusat</td>
<td></td>
<td>Jl. Raya Gangsiran Wetan No. 9 RT/RW 01/
03, Ds. Tlekung, Kec. Junrejo, Batu</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>Drs. M. Rosyidi Ims, MM</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>341</td>
<td></td>
<td>PT. Al Nita</td>
<td>Pusat</td>
<td></td>
<td>Jl. Kiprah Blok III No. 12, Blitar</td>
<td></td>
<td>Eko Kustyanto</td>
<td>L</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>342</td>
<td></td>
<td>PT. Hudian Lestari Makmur</td>
<td>Pusat</td>
<td></td>
<td>Jl. Merdeka No. 68, Jabung Talun, Blitar
</td>
<td></td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>343</td>
<td></td>
<td>Cabang</td>
<td></td>
<td>Jl. K.H. Wakhid Hasyim No. 63, Kediri</t
d>
<td></td>
<td>Nurjanah</td>
<td>P</td>
<td>446/7096/4.19.41/2006</td>
<td></td>
<td>Eddy Wijaya</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>344</td>
<td></td>
<td>Cabang</td>
<td></td>
<td>Jl. Semeru No. 25 B, Kediri</td>
<td></td>
<td>Dewi Setyarini, S.Farm., Apt</td>
<td>P</td>
<td>19830401/STRA-USB/2006/224964</td>
<td></td>
<td>Sinyo M.Kolinug</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>345</td>
<td></td>
<td>PT. Lestari Jaya Farma</td>
<td>Pusat</td>
<td></td>
<td>Jl. Dr. Sutomo No. 54, Kediri</td>
<td></td>
<td>Dian Pratiwi Widjaya, S.Farm, Apt</td>
<td>P</td>
<td>KP.01.03.1.3.1640</td>
<td></td>
<td>Aniek Suryani</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>346</td>
<td></td>
td>
<td>Cabang</td>
<td></td>
<td>Jl. Brigjen Katamso No. 80, Kediri</td>
<td></td>
<td>Hendro Koeswantoro</td>
<td>L</td>
<td>446/916/419/412004</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>347</td>
<td></td>
<td>PT. Tinalan Andatu Lestari</td>
<td>Pusat</td>
<td></td>
<td>Jl. B. Pol. Ibh. Pranoto No. 11 A, Kedir
i</td>
<td></td>
<td>Imelda Agustina Cahyono, S.Farm., Apt</t
d>
<td>P</td>
<td>19820827/STRA-UWM/2007/214942</td>
<td></td>
<td>Teddy Saputra</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>348</td>
<td></td>
<td>Cabang</td>
<td></td>
<td>Jl. Dewi Sartika No. 8-10, Kediri</td>
<td></td>
<td>Nailul Islakhiyah, S.Farm., Apt</td>
<td>P</td>
<td>KP.01.01.1.3.3732</td>
<td></td>
<td>Jogi Tri Basuki</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>349</td>
<td></td>
<td>PT. Junger Farma</td>
<td>Cabang</td>
<td></td>
<td>Jl. Raya Persada Sayang No. 2, Kediri</t
d>
<td></td>
<td>Winoto Adi Harsanto, S.Farm., Apt</td>
<td>P</td>
<td>19860826/STRA-UMS/2011/12339</td>
<td></td>
<td>Siswanto</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>350</td>
<td></td>
<td>PT. Dhoho Nauli</td>
<td>Cabang</td>
<td></td>
<td>Dandangan II/14</td>
<td></td>
<td>Dwi Widarti</td>
<td>P</td>
<td>446/6790/419.41/2006</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>351</td>
<td></td>
<td>PT. Daya Manunggal</td>
<td>Pusat</td>
<td></td>
<td></td>
<td>Simuarsih</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>352</td>
<td></td>
<td>PT. Mitra Farma Anugerah</td>
<td>Pusat</td>
<td></td>
<td>Jl. Slamet Riyadi No. 17, Kediri</td>
<td></td>
<td>Atika Kirana, S.Farm., Apt</td>
<td>P</td>
<td>19870920/STRA-UBAYA/2010/224469</td>
<td></td>
<td>Sri Tindarwati</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>353</td>
<td></td>
<td>CV. Fasta Jaya</td>
<td>Pusat</td>
<td></td>
<td>Jl. Penanggungan No. 11, Kediri</td>
<td></td>
<td>Supiyah</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>354</td>
<td></td>
<td>CV. Cahaya Jaya</td>
<td>Pusat</td>
<td></td>
<td>Jl. Mastrip No. 139, Kediri</td>
<td></td>
<td>Rikawati</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>355</td>
<td></td>
<td>PT. Bahtera Talenta Jaya</td>
<td>Pusat</td>
<td></td>
<td>Jl. Semeru No. 182, Kediri</td>
<td></td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>356</td>
<td></td>
<td>PT. Bhakti Usaha Purna Wira</td>
<td>Pusat</td>
<td></td>
<td>Jl. Dandangan III/28, Kediri</td>
<td></td>
<td>Sektyowati</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>357</td>
<td></td>
<td>Cabang</td>
<td></td>
<td>Jl. Gatot Subroto No. 153, Kediri</td>
<td></td>
<td>Lisa Iriani., S.Farm, Apt</td>
<td>P</td>
<td>19861019/STRA-USB/2011/22466</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>358</td>
<td></td>
<td>Cabang</td>
<td></td>
<td></td>
<td>Betty Rosiana Ulfah</td>
<td>P</td>
<td>19880211/STRA-UNAIR/2011/23978</td>
<td></td>
<td>Arifudin</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>359</td>
<td></td>
<td>Cabang</td>
<td></td>
<td>Jl. Slamet Riadi No. 16, Banjaran, Kedir
i</td>
<td></td>
<td>Mulyani, S.Farm., Apt</td>
<td>P</td>
<td>19870626/STRA-UMS/2011/28641</td>
<td></td>
<td>Dedi Kurniadi</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>360</td>
<td></td>
<td>PT. Kallista Prima</td>
<td>Cabang</td>
<td></td>
<td>Jl. Bandar Lor Gang II/36A, Kediri</td>
<td></td>
<td>Anistisia Frina Dinarsari, S.Farm., Apt<
/td>
<td>P</td>
<td>19860731/STRA-UNAIR/2010/218138</td>
<td></td>
<td>Edwin Eko Putro</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>361</td>
<td></td>
<td>PT. Elang Persada Medika</td>
<td>Pusat</td>
<td></td>
<td>Jl. Depok Manis No. 2, Manisrejo, Taman,
Madiun</td>
<td></td>
<td>Yayik Dwi Primadani, S.Farm., Apt</td>

<td>P</td>
<td>19870401/STRA-UMS/2011/226597</td>
<td></td>
<td>Bambang Kamahayanikan</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>362</td>
<td></td>
td>
<td>Cabang</td>
<td></td>
<td>Jl. Setiabudi No. 10, Madiun</td>
<td></td>
<td>Andika Feriosa</td>
<td>P</td>
<td>503/1972/401.103/AA.153/2010</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>363</td>
<td></td>
<td>Cabang</td>
<td></td>
<td>Jl. Yos Sudarso No. 29-31, Madiun</td>
<td></td>
<td>Ana Faridha, S.Farm., Apt</td>
<td>P</td>
<td>19870918/STRA-USB/2011/22400</td>
<td></td>
<td>Mahmudi</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>364</td>
<td></td>
<td>Cabang</td>
<td></td>
<td>Jl. Tanjung Raya No. 42, Manisrejo, Madi
un</td>
<td></td>
<td>Safrida Nugrahenny, S.Farm., Apt</td>
<td>P</td>
<td>KP.01.03.1.3.3766</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>365</td>
<td></td>
<td>PT. Lady Pharmindo</td>
<td>Pusat</td>
<td></td>
<td>Jl. Sulawesi No. 16A, Madiun</td>
<td></td>
<td>Sri Yudho Endang P</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>366</td>
<td></td>
<td>PT. Sentra Waras</td>
<td>Pusat</td>
<td></td>
<td>Jl. Bali No. 20, Madiun </td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>367</td>
<td></td>
<td>PT. KPRI Husada Sejahtera</td>
<td>Pusat</td>
<td></td>
<td>Jl. Sumbawa No. 11, Madiun</td>
<td></td>
<td>Frensikatua Ariyanti</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>368</td>
<td></td>
<td>PT. Wahyu Mitra Sejati</td>
<td>Pusat</td>
<td></td>
<td>Jl. Margahayu No. 3, Madiun </td>
<td></td>
<td>Lidia Sitepy</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>369</td>
<td></td>
<td>PT. Tunggal Jaya Farma</td>
<td>Pusat</td>
<td></td>
<td>Jl. Diponegoro, Madiun</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>370</td>
<td></td>
<td>PT. Lia Mitra Usaha</td>
<td>Pusat</td>
<td></td>
<td>Jl. Cokroaminoto No. 102, Madiun</td>
<td></td>
<td>Drs. Bambang Soemitro Abdoellah, Apt</td
>
<td>L</td>
<td>SIK 2569/B</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>371</td>
<td></td>
<td>PT. Tetap Jaya Farma</td>
<td>Pusat</td>
<td></td>
<td>Jl. Tawang Baru No. 9, Madiun</td>
<td></td>
<td>Widayati Sudcoro Edi</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>372</td>
<td></td>
<td>PT. Gunung Kencana Mulya</td>
<td>Pusat</td>
<td></td>
<td>Perum Bumi Mas Blok J/13, Madiun</td>
<td></td>
<td>Susi Waijayanti</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>373</td>
<td></td>
<td>PT. Indofarma Global Medika</td>
<td>Cabang</td>
<td></td>
<td>Jl. Setya Bakti No. 17, Madiun</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>374</td>
<td></td>
<td>PT. Andalas Putra Mandiri</td>
<td>Cabang</td>
<td></td>
<td>Jl. Thamrin No. 61, Madiun</td>
<td></td>
<td>Farida Kushartati</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>375</td>
<td></td>
<td>Cabang</td>
<td></td>
<td>Jl. Manggar Manis No. 3, Madiun</td>
<td></td>
<td>Feria Purna Dwiati</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>376</td>
<td></td>
>
<td>Cabang</td>
<td></td>
<td>Jl. Dr. Soetomo No. 33, Madiun</td>
<td></td>
<td>Ninin Wahyuni, S.Farm., Apt</td>
<td>P</td>
<td>198801112/STRA-UWM/2006/222915</td>
<td></td>
<td>Imam Supingi</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>377</td>
<td></td>
<td>Cabang</td>
<td></td>
<td>Jl. Karya Barat No. 5, Malang</td>
<td></td>
<td>Angga Tan Satresna, S.Farm., Apt</td>
<td>L</td>
<td>19880306/STRA-UNAIR/2011/11020</td>
<td></td>
<td>Andi Supandi</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>378</td>
<td></td>
<td>PT. Daya Muda Agung</td>
<td>Cabang</td>
<td></td>
<td>Jl. Terusan Batubara No. 30 C, Malang</t
d>
<td></td>
<td>Nela Oktaviani, S.Farm., Apt</td>
<td>P</td>
<td>19881011/STRA-UAD/2012/226237</td>
<td></td>
<td>Santoso</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>379</td>
<td></td>
<td>PT. United Dico Citas</td>
<td>Cabang</td>
<td></td>
<td>Jl. Nangka No. 11, Malang</td>
<td></td>
<td>Febrind Chandikya Nuria Majid, S.Farm, A
pt</td>
<td>P</td>
<td>19870204/STRA-UMS/2011/16334</td>
<td></td>
<td>Faisal, ST</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>380</td>
<td></td>
<td>PT. Parit Padang Global</td>
<td>Cabang</td>
<td></td>
<td>Jl. Tenaga Baru I No. 11 A, Malang</td>
<td></td>
<td>Yusiska Fitrianty</td>
<td>P</td>
<td>19871211/STRA-UWM/2011/26193</td>
<td></td>
<td>Jauw Herry</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>381</td>
<td></td>
<td>PT. Tempo</td>
<td>Cabang</td>
<td></td>
<td>Jl. Raya Tlogo Mas No. 26-27, Malang</td
>
<td></td>
<td>Khoridah Septiningtyas, S.Farm., Apt</td
>
<td>P</td>
<td>19880913/STRA-UNAIR/2011/24046</td>
<td></td>
<td>Ai Ju, SE</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>382</td>
<td></td>
<td>PT. Dwi Putra Glory</td>
<td>Pusat</td>
<td></td>
<td>Jl. Blimbing Indah Tengah XVI Blok L1 No
. 24, Malang</td>
<td></td>
<td>Farid Zulkarnain Nur Syah</td>
<td>L</td>
<td>KP.01.03.13.4937</td>
<td></td>
<td>Jimmy Hertanto</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>383</td>
<td></td>
<td>PT. Imanuel Mulia Farma</td>
<td>Pusat</td>
<td></td>
<td>Jl. Tenaga Baru II No. 5, Malang</td>
<td></td>
<td>Drs.Hadi, Apt</td>
<td>L</td>
<td>Kp.01.01.V.5.2.10371</td>
<td></td>
<td>Sulaiman Iskandar</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>384</td>
<td></td>
<td>PT. Kinarya Jaya Abadi</td>
<td>Pusat</td>
<td></td>
<td>Jl. LA. Sucipto No. 203, Malang</td>
<td></td>
<td>Reny Pratiwi,S.Farm,Apt</td>
<td>P</td>
<td></td>
<td></td>
<td>Miftakhul Hidayat</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>385</td>
<td></td>
<td>Cabang</td>
<td></td>
<td>Jl. Sulfat Tengah No.16</td>
<td></td>
<td>Indah Purnama Dewi, S.Farm., Apt</td>
<td>P</td>
<td>KP.01.03.1.3.1434</td>
<td></td>
<td>Mahmud Sarbin</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>386</td>
<td></td>
<td>PT. Antar Mitra Sembada</td>
<td>Cabang</td>
<td></td>
<td>Jl. Baluran No. 8, Malang</td>
<td></td>
<td>Nia Grahadian, S.Farm., Apt</td>
<td>P</td>
<td>19850718/STRA-UGM/2009/222546</td>
<td></td>
<td>Ir. Agung Widyanto</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>387</td>
<td></td>
td>
<td>Cabang</td>
<td></td>
<td>Pondok Belimbing Indah Utara IV-2 Blok A
1/19, Malang</td>
<td></td>
<td>Leoni Wahyu Pramono, S.Farm., Apt.</td>
<td>L</td>
<td>19860727/STRA-USB/2009/23506</td>
<td></td>
<td>M.Ali Imran</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>388</td>
<td></td>
<td>PT. Kebayoran Farma</td>
<td>Cabang</td>
<td></td>
<td>Jl. Hamid Rusdi No. 93, Malang</td>
<td></td>
<td>Esti Chandra Rini, S.Farm, Apt</td>
<td>P</td>
<td>KP.01.03.1.3.3308</td>
<td></td>
<td>Hery Winarto</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>389</td>
<td></td>
<td>Cabang</td>
<td></td>
<td>Jl. Janti Barat Blok A/48, Malang</td>
<td></td>
<td>Ritma Nur Laila</td>
<td>P</td>
<td>19871228/STRA-UNAIR/2012/225617</td>
<td></td>
<td>Panca Adi Saha Dewa</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>390</td>
<td></td>
<td>Cabang</td>
<td></td>
<td>Jl. Sunandar Priyo Sudarmo No. 26, Malan
g</td>
<td></td>
<td>Ratih Dewi Primahartutie, S.Farm., Apt</
td>
<td>P</td>
<td>19850517/STRA-UNAIR/2008/222558</td>
<td></td>
<td>Suwanto</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>391</td>
<td></td>
td>
<td>Cabang</td>
<td></td>
<td>Jl. Hamid Rusdi No. 95, Kec. Blimbing, M
alang</td>
<td></td>
<td>Ayu Andini Ibrahim, S.Farm., Apt</td>
<td>P</td>
<td>19871219/STRA-UBAYA/2011/215661</td>
<td></td>
<td>Eddy Mulyadi</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>392</td>
<td></td>
<td>Cabang</td>
<td></td>
<td>Jl. Taman Tenaga Kav 6, Malang</td>
<td></td>
<td>Yuni Mariyana ,S.Farm.Apt</td>
<td>P</td>
<td>19810618/STRA-UGM/2006/224450</td>
<td></td>
<td>Yohanes Choa</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>393</td>
<td></td>
<td>PT. Adi Buana Citra Dharmala</td>
<td>Pusat</td>
<td></td>
<td>Jl. Candi Panggung No. 1 G, Malang</td>
<td></td>
<td>Sulistinah Ningsih</td>
<td>P</td>
<td>-</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>394</td>
<td></td>
<td>PT. Anugrah Argon Medica</td>
<td>Cabang</td>
<td></td>
<td>Jl. Simpang Ranugrati No. 20, Malang</td
>
<td></td>
<td>Ricka Priscillia, S.Farm., Apt</td>
<td>P</td>
<td>19880710/STRA-UBAYA/2011/220550</td>
<td></td>
<td>Yulius Hendro Sudjarwanto</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>395</td>
<td></td>
<td>PT. Arta Boga Cemerlang</td>
<td>Pusat</td>
<td></td>
<td>Jl. Sunandar Priyosudarmo, Malang</td>
<td></td>
<td>Dra. Liana Gunawan,Apt</td>
<td>P</td>
<td>5016/B</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>396</td>
<td></td>
<td>PT. Enseval Putra Megatrading Tbk</td>
<td>Cabang</td>
<td></td>
<td>Jl. Industri No. 90, Ds Mangliawan Pakis
, Malang</td>
<td></td>
<td>Ersy Kristanty</td>
<td>P</td>
<td>077/Kab.Mlh/SIKAA X/07</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>397</td>
<td></td>
<td>PT. Junger Farma Distribusi</td>
<td>Cabang</td>
<td></td>
<td>Jl. Bantaran Barat II/37, Malang</td>
<td></td>
<td>Romdhoni, S.Farm., Apt</td>
<td>L</td>
<td>19860603/STRA-UMS/2011/12328</td>
<td></td>
<td>Pratomi Alam Gunawan</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>398</td>
<td></td>
<td>PT. Samudra Artha Pharmasino</td>
<td>Pusat</td>
<td></td>
<td>Jl. Pasir Putih No. 5, Malang</td>
<td></td>
<td>Marlina Septiana</td>
<td>P</td>
<td>0501.754.AA</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>399</td>
<td></td>
<td>PT. Tunggal Sila Farma</td>
<td>Cabang</td>
<td></td>
<td></td>
<td>Mamiik Winarti</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>400</td>
<td></td>
<td>PT. Ultra Bintang Jaya Putra</td>
<td>Cabang</td>
<td></td>
<td>Jl. Sunandar Priyo Sudarmo Kav A 36, Mal
ang</td>
<td></td>
<td>Pusparini</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>401</td>
<td></td>
<td>PT. Waluyo Agung Sejati</td>
<td>Pusat</td>
<td></td>
<td>Jl. Kelud No. 12, Malang</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>402</td>
<td></td>
<td>PT. Zaifaza Farma</td>
<td>Pusat</td>
<td></td>
<td>Jl. Sukarno Hatta No. 7, Mojolangu, Mala
ng</td>
<td></td>
<td>Enny Wasaningsih Pramono</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>403</td>
<td></td>
<td>PT. Tadjur Putra Mandiri</td>
<td>Cabang</td>
<td></td>
<td>Jl. Kesatrian Dalam No. 22, Malang</td>
<td></td>
<td>Kartini</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>404</td>
<td></td>
<td>PT. Lab Medika Sejahtera</td>
<td>Cabang</td>
<td></td>
<td>Jl. Kebalen No. 1B, Malang</td>
<td></td>
<td>P</td>
<td>-</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>405</td>
<td></td>
<td>PT. Sawah Besar Farma</td>
<td>Cabang</td>
<td></td>
<td>Jl. Simpang Barito I/1, Malang</td>
<td></td>
<td>Tri Indah Nuryanti</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>406</td>
<td></td>
<td>PT. Savero Farma</td>
<td>Cabang</td>
<td></td>
<td>Jl. Raya Dieng No. 32, Malang</td>
<td></td>
<td></td>
<td></td>
<td>-</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>407</td>
<td></td>
<td>Cabang</td>
<td></td>
<td>Jl. Topas No. 18, Tlogomas Lowok Waru, M
alang</td>
<td></td>
<td>Perawati, S.Farm., Apt</td>
<td>P</td>
<td>19850419/STRA-USB/2009/210086</td>
<td></td>
<td>Drs. Imam Masduki</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>408</td>
<td></td>
<td>PT. Santa Abadi</td>
<td>Pusat</td>
<td></td>
<td></td>
<td></td>
<td>Erlin Juni Triastutii</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>409</td>
<td></td>
<td>PT. Wigo</td>
<td>Cabang</td>
<td></td>
<td>Jl. WR. Supratman No. 6, Malang</td>
<td></td>
<td>Nanik Susilowati</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>410</td>
<td></td>
<td>PT. Guntor Misri Sentosa</td>
<td>Pusat</td>
<td></td>
<td></td>
<td></td>
<td>Linda Ikaning W</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>411</td>
<td></td>
<td>PT. Hanjaya Perkasa Lestari Farma</td>
<td>Cabang</td>
<td></td>
<td>Jl. Papandayan No. 10, Malang</td>
<td></td>
<td>Dewi Utarini</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>412</td>
<td></td>
<td>PT. Hasma Jaya Agung</td>
<td>Pusat</td>
<td></td>
<td>Jl. Danau Singkarak No. E3, A12, Malang<
/td>
<td></td>
<td>Mundari</td>
<td>P</td>
<td>31786</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>413</td>
<td></td>
<td>PT. Hikmat Sejati Gemilang Farma</td>
<td>Pusat</td>
<td></td>
<td>Jl. Raya Langsep No. 63, Malang</td>
<td></td>
<td>I.G.Santoso</td>
<td>L</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>414</td>
<td></td>
<td>PT. Husena Pharmacy</td>
<td>Pusat</td>
<td></td>
<td>Jl. Jaksa Agung Suprapto No. 62, Malang<
/td>
<td></td>
<td></td>
<td></td>
<td>-</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>415</td>
<td></td>
<td>PT. Trisula Manunggal Jaya</td>
<td>Pusat</td>
<td></td>
<td>Jl. Letjen S.Parman No. 26, Malang</td>
<td></td>
<td>Filumena Trijanti P</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>416</td>
<td></td>
<td>Cabang</td>
<td></td>
<td>Jl. Tenaga Baru Blok B II/16, Malang</td
>
<td></td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>417</td>
<td></td>
<td>PT. Minaroza Farma</td>
<td>Pusat</td>
<td></td>
<td>Jl. Soekarno Hatta No. 7, Malang</td>
<td></td>
<td>L</td>
<td>446.AA/237/SIK/3573.306/2009</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>418</td>
<td></td>
<td>PT. Pangestu Farmindo Muliatama</td>
<td>Pusat</td>
<td></td>
<td>Jl. Arjuna No. 34, Malang</td>
<td></td>
<td>Ninik Winarti.</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>419</td>
<td></td>
<td>PT. Benteng Gading Gemilang</td>
<td>Pusat</td>
<td></td>
<td>Jl. Titan VI/R.11, Malang</td>
<td></td>
<td>Nur Hidayati</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>420</td>
<td></td>
<td>Cabang</td>
<td></td>
<td>Jl. A.Yani No. 138, Malang</td>

<td></td>
<td>Pungki Kusuma Jayanti, S.Farm., Apt</td>
<td>P</td>
<td>19841107/STRA-UNAIR/2011/24003</td>
<td></td>
<td>Robertus Ratna Hadi Lesmana</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>421</td>
<td></td>
<td>Cabang</td>
<td></td>
<td></td>
<td>Nurul Fitriyani, S.Farm., Apt</td>
<td>P</td>
<td>19830703/STRA-USB/2011/22486</td>
<td></td>
<td>Agung Wibowo</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>422</td>
<td></td>
<td>PT. Distiversa Buanamas</td>
<td>Cabang</td>
<td></td>
<td>Jl. Kunir No. 5, Malang</td>
<td></td>
<td>Dwi Prawita Widatama, S.Farm., Apt</td>
<td>P</td>
<td>19870908/STRA-UWM/2011/11651</td>
<td></td>
<td>Harijono</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>423</td>
<td></td>

>
<td>Cabang</td>
<td></td>
<td>Jl. A.Yani Utara No. 2, Malang</td>
<td></td>
<td>Sunarsih</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>424</td>
<td></td>
<td>Cabang</td>
<td></td>
<td>Jl. Teluk Etna V/86, Malang</td>
<td></td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>425</td>
<td></td>
<td>PT. Sandhana Mundi Sentosa</td>
<td>Pusat</td>
<td></td>
<td>Jl. Pelabuhan Tanjung Mas, Malang</td>
<td></td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>426</td>
<td></td>
<td>Cabang</td>
<td></td>
<td>Jl. Delima No. 7, Malang</td>
<td></td>
<td>Dina Wifada, S.Farm., Apt</td>
<td>P</td>
<td>19850709/STRA-UNAIR/2011/214064</td>
<td></td>
<td>Suhardiyo</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>427</td>
<td></td>
<td>PT. Dwilandra Hida Utama</td>
<td>Cabang</td>
<td></td>
<td>Jl. Larvo E/30, Malang</td>
<td></td>
<td>Sri Naningsih</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>428</td>
<td></td>
<td>PT. Duta Dwi Sarana Prima</td>
<td>Cabang</td>
<td></td>
<td>Jl. Tapak Liman No. 15, Malang</td>
<td></td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>429</td>
<td></td>
<td>PT. Endojeris</td>
<td>Pusat</td>
<td></td>
<td>Jl. Andalas Tengah No. 23, Malang</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>430</td>
<td></td>
<td>PT. Fitalab Utama Karya</td>
<td>Cabang</td>
<td></td>
<td>Jl. Tenaga Tengah No. 5, Malang</td>
<td></td>
<td>Koenarno</td>
<td>L</td>
<td>446.AA/258/K/35.73.306/2009</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>431</td>
<td></td>
<td>PT. Aloha Jaya</td>
<td>Cabang</td>
<td></td>
<td>Jl. Suropati No. 40, Malang</td>
<td></td>
<td>Fajar Arifianto</td>
<td>L</td>
<td>446.AA/258/K/35.73.306/2009</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>432</td>
<td></td>
<td>PT. Pramumitra Pharma</td>
<td>Pusat</td>
<td></td>
<td>Jl. Kaliurang Barat No. 113, Malang</td>
<td></td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>433</td>
<td></td>
<td>PT. Parazelsus Indonesia</td>
<td>Cabang</td>
<td></td>
<td></td>
<td>Syahrial Fahrudin, S.Farm., Apt</td>
<td>L</td>
<td>19851029/STRA-UAD/2010/16479</td>
<td></td>
<td>Dian Purwito Utomo</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>434</td>
<td></td>
<td>PT. Parit Karya</td>
<td>Pusat</td>
<td></td>
<td>Jl. Cipunegara No. 38, Malang</td>
<td></td>
<td>Kustia M</td>
<td>P</td>
<td>446.AA/196/SIK/3573.306/2008</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>435</td>
<td></td>
<td>PT. Great Mataram</td>
<td>Cabang</td>
<td></td>
<td>Jl. Batanghari No. 3, Malang</td>
<td></td>
<td>Heny Sukatmi</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>436</td>
<td></td>
<td>PT. Graha Kandhi Farma</td>
<td>Cabang</td>
<td></td>
<td></td>
<td>Siti Marfuatul Fitriyah</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>437</td>
<td></td>
<td>PT. Gala Jaya Raya</td>
<td>Cabang</td>
<td></td>
<td>Jl. Timah No. 10, Malang</td>
<td></td>
<td>Sukarti</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>438</td>
<td></td>
<td>PT. Intan Baskara Mandiri</td>
<td>Pusat</td>
<td></td>
<td>Jl. Sultan Agung No. 12, Malang</td>
<td></td>
<td>Novatum, S.Farm., Apt</td>
<td>P</td>
<td>19831106/STRA-USB/2012/225833</td>
<td></td>
<td>Marselinus Maring</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>439</td>
<td></td>
<td>PT. Dasamitra Sembada Pharma</td>
<td>Pusat</td>
<td></td>
<td>Jl. Danau Toba C-37, Sawojajar, Malang</
td>
<td></td>
<td>Sri Pujiastuti, S.Farm., Apt</td>
<td>P</td>
<td>19871207/STRA-UAD/2012/226281</td>
<td></td>
<td>Dian Ika Prasetyawan</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>440</td>
<td></td>
<td>PT. Mina Karya Usaha</td>
<td>Pusat</td>
<td></td>
<td>Jl. Sukarno Hatta No. 7, Malang</td>
<td></td>
<td>Furaida Arifani, S.Farm., Apt</td>
<td>P</td>
<td>19871207/STRA-UAD/2011/24108</td>
<td></td>
<td>Purwanto</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>441</td>
<td></td>
<td>Cabang</td>
<td></td>
<td>Jl. Teluk Etna V/86, RT/RW 02/04, Malang
</td>
<td></td>
<td>Herlina Septika, S.Farm., Apt</td>
<td>P</td>
<td>19840717/STRA-UNAIR/2007/215343</td>
<td></td>
<td>Maria Kurniawati</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>442</td>
<td></td>
<td>Cabang</td>
<td></td>
<td>Jl. Kyai Tamin No. 15/I-J, Malang</td>
<td></td>
<td>Enggar Mardaresta, S.Farm., Apt</td>
<td>P</td>
<td>19860307/STRA-USB/2009/215324</td>
<td></td>
<td>Mohamad Faizal Yusuf</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>443</td>
<td></td>
<td>Cabang</td>
<td></td>
<td>Jl. Panji Suroso No. 20, Malang</td>
<td></td>
<td>Ratna Mustika Cahyaningrum, S.Farm., Apt
</td>
<td>P</td>
<td>18980723/STRA-UAD/2012/225747</td>
<td></td>
<td>Hary Soetanto</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>444</td>
<td></td>
<td>PT. Walisongo</td>
<td>Pusat</td>
<td></td>
<td>Jl. Brantas No. 175, Kademangan, Proboli
nggo</td>
<td></td>
<td>Yuni Candra Hapsari</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>445</td>
<td></td>
<td>PT. Aditya Farmatama</td>
<td>Cabang</td>
<td></td>
<td>Jl. Rungkur Asri Barat XII/31, Surabaya<
/td>
<td></td>
<td>Ani Suyatmi</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>446</td>
<td></td>
<td>PT. Antar Mitra Sembada Cabang Surabaya
2</td>
<td>Cabang</td>
<td></td>
<td>Jl. Putat Gede Indah No. 2-A, Surabaya</
td>
<td></td>
<td>Didit Pradipta, S.Farm., Apt</td>
<td>L</td>
<td>19880506/SIKA-35.78/2012/1015</td>
<td></td>
<td>Sabarudin Halawa</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>447</td>
<td></td>
<td>PT. Anugrah Argon Medica Cabang Surabaya
1</td>
<td>Cabang</td>
<td></td>
<td>Jl. Klampis Jaya No. 31 Blok J-K-L, Sura
baya</td>
<td></td>
<td>Meilia Puspita Sari., S.Farm., Apt</td>
<td>P</td>
<td>19850507/STRA-UWM/2011/26219</td>
<td></td>
<td>Robertus Eko Susetyo W.E</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>448</td>
<td></td>
<td>Cabang</td>
<td></td>
<td>Jl. Berbek Industri I No. 1 B-C, Waru</t
d>
<td></td>
<td>Kiki Kulia Aulia Haqque,S.Farm,Apt</td>
<td>P</td>
<td>KP.01.03.1.3.0131</td>
<td></td>
<td>joshijanto Tanuhadi</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>449</td>
<td></td>
<td>PT. Bina San Prima Cabang Surabaya 1</td
>
<td>Cabang</td>
<td></td>
<td>Jl. Raya Gubeng No. 16, Surabaya</td>
<td></td>
<td>Noviane Tanzil, S.Farm., Apt</td>
<td>P</td>
<td>19881102/STRA-UWM/2012/227473</td>
<td></td>
<td>Hondo Wahono</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>450</td>
<td></td>
<td>PT. Cempaka Indah Murni</td>
<td>Cabang</td>
<td></td>
<td>Jl. Gayungan PPN No. 7, Surabaya</td>
<td></td>
<td>Linda Kusumawati, S.Farm., Apt</td>
<td>P</td>
<td>19890610/STRA-UBAYA/2012/227121</td>
<td></td>
<td>F. Handoko Sasmito</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>451</td>
<td></td>
<td>PT. Dalan Triputra Mandiri</td>

<td>Pusat</td>
<td></td>
<td>Jl. Raya Kalirungkut 1-3 Blok N-12 Ruko,
Surabaya</td>
<td></td>
<td>Dyah Ayu Citrawati, S.Farm., Apt</td>
<td>P</td>
<td>19821120/STRA-UWM/2008/214736</td>
<td></td>
<td>Erni Wahyuningsih</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>452</td>
<td></td>
<td>PT. Enggang Mulia Nusa</td>
<td>Pusat</td>
<td></td>
<td>Jl. Rungkut Madya No. 163, Surabaya</td>
<td></td>
<td>Titiek Ruswatiningsih</td>
<td>P</td>
<td>111.613/SIAA/331/01679/VII/08</td>
<td></td>
<td>Herri</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>453</td>
<td></td>
<td>Cabang</td>
<td></td>
<td>Jl. Raya Kendangsari No. 45-47, Surabaya
</td>
<td></td>
<td>Yunita Irwanto, S.Farm., Apt</td>
<td>P</td>
<td>19830607/STRA-UBAYA/2006/221131</td>
<td></td>
<td>Suwandy Kamaluddin</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>454</td>
<td></td>
<td>PT. Gehael Nusantara</td>
<td>Pusat</td>
<td></td>
<td>Jl. Kencanasari Barat II/AA-7, Surabaya<
/td>
<td></td>
<td>Tri Puspasari, S.Farm., Apt.</td>
<td>P</td>
<td>19870205/STRA-UWM/2011/219881</td>
<td></td>
<td>Dra. Lily Sandra Wijaya</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>455</td>
<td></td>
<td>PT. Gelora Fajar Farma</td>
<td>Cabang</td>
<td></td>
<td>Jl. Margorejo Indah II/A-232, Surabaya</
td>
<td></td>
<td>Merry Santoso., S.Farm., Apt</td>
<td>P</td>
<td>19880715/STRA-UWM/2011/26217</td>
<td></td>
<td>Moeliono Soetanto</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>456</td>
<td></td>
<td>PT. Gemini Mandira Lestari</td>
<td>Pusat</td>
<td></td>
<td>Jl. Medokan Ayu MA II/O No. 9, Surabaya<
/td>
<td></td>
<td>Veronica Soejanto S.Farm., Apt</td>
<td>P</td>
<td>19830823/STRA-UWM/2008/219091</td>
<td></td>
<td>George A. Tanara</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>457</td>
<td></td>
<td>PT. Global Persada Farma</td>
<td>Cabang</td>
<td></td>
<td>Jl. Kaliwaron No. 136, Surabaya</td>
<td></td>
<td>Nurma Yunita Arvianti</td>
<td>P</td>
<td>19870627/STRA-UWM/2010/212801</td>
<td></td>
<td>Anshori Rusydi</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>458</td>
<td></td>
<td>Cabang</td>
<td></td>
<td>Jl. Raya Margorejo Indah Blok A-137/58,
Surabaya</td>
<td></td>
<td>Fitrieny Namelia, S.Farm., Apt</td>
<td>P</td>
<td>19830506/STRA-UGM/2008/214695</td>
<td></td>
<td>Wahyu Dewantoro</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>459</td>
<td></td>
<td>PT. Inti Mulia Farma</td>
<td>Pusat</td>
<td></td>
<td>Jl. Pucang Jajar No.43-45, Surabaya</td>
<td></td>
<td>Anastasia Ira Simanto, S.Farm, Apt.</td>
<td>P</td>
<td>19860416/STRA-UBAYA/2009/218641</td>
<td></td>
<td>Jimmy Agustiawan Liono</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>460</td>
<td></td>
<td>PT. Junger Farma Distribusi</td>
<td>Cabang</td>
<td></td>
<td>Jl. Kertajaya Indah Timur I/14, Surabaya
</td>
<td></td>
<td>Wahid Bekti Fitrianto, S.Farm., Apt</td>
<td>L</td>
<td>19860626/STRA-UMS/2011/12327</td>
<td></td>
<td>Septi Ichtiadi</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>461</td>
<td></td>
td>
<td>Cabang</td>
<td></td>
<td>Jl. Raya Jemursari No. 41, Surabaya</td>
<td></td>
<td>Ayek Dwi Rosiana, S.Farm., Apt</td>
<td>P</td>
<td>19880404/STRA-UNAIR/2011/24022</td>
<td></td>
<td>Alwi, S.Si</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>462</td>
<td></td>
<td>Cabang</td>
<td></td>
<td>Jl. Mojoklanggru No. 227, Surabaya</td>
<td></td>
<td>Dyaninta Yudhiarini, S.Farm., Apt</td>
<td>P</td>
<td>19870428/STRA-UBAYA/2011/215665</td>
<td></td>
<td>Djony Liem Joeng Ming</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>463</td>
<td></td>
<td>Cabang</td>
<td></td>
<td>Jl. Darmokali No. 32, Surabaya</td>
<td></td>
<td>Sonya Trisnowati, S.Farm., Apt</td>
<td>P</td>
<td>19841114/STRA-UNAIR/2009/223058</td>
<td></td>
<td>Achmad Badri</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>464</td>
<td></td>
<td>PT. Multi Dwi Abadi</td>
<td>Pusat</td>
<td></td>
<td>Jl. Rungkut Industri IV/14, Surabaya</td
>
<td></td>
<td>Retno Kuswariningsih,S,Si,Apt</td>
<td>P</td>
<td>KP.01.01.1.2.1186</td>
<td></td>
<td>Edwin Surya</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>465</td>
<td></td>
<td>PT. Osadha Graha Sejahtera</td>
<td>Cabang</td>
<td></td>
<td>Jl. Raya Menganti Wiyung, Perum Pratama,
Ruko A-12, Surabaya</td>
<td></td>
<td>Loly Aria Ratna</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>466</td>
<td></td>
<td>PT. Parit Padang Global Cabang Surabaya
2</td>
<td>Cabang</td>
<td></td>
<td>Jl. Rungkut Industri I No. 19, Surabaya<
/td>
<td></td>
<td>Feronika Rasubala ,S.Farm,Apt</td>
<td>P</td>
<td>KP.01.03.1.3.1752</td>
<td></td>
<td>Setiawan Antoni</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>467</td>
<td></td>
<td>PT. Prima Farmasindo Lestari</td>
<td>Pusat</td>
<td></td>
<td>Jl. Kenjeran No. 631, Surabaya</td>
<td></td>
<td>Verronisa Ermiani, S.Farm, Apt</td>
<td>P</td>
<td>19861204/STRA-UNAIR/2011/212819</td>
<td></td>
<td>Tjomo Tjengundoro</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>468</td>
<td></td>
<td>PT. Rachma Medica</td>
<td>Pusat</td>
<td></td>
<td>Jl. Arjuno No. 2-D, Surabaya</td>
<td></td>
<td>Aulia Dewi Hapsari,S.Farm,Apt</td>
<td>P</td>
<td>KP. 01.03.1.3.5658</td>
<td></td>
<td>H. Sulbi Baera</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>469</td>
<td></td>
<td>Cabang</td>
<td></td>
<td>Jl. Rungkut Industri VIII/39, Surabaya</
td>
<td></td>
<td>Aina Mujtahida Alwan,S.Farm.Apt</td>
<td>P</td>
<td>149861218/STRA-UNAIR/2011/25791</td>
<td></td>
<td>Johannes Ferryanto</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>470</td>
<td></td>
<td>PT. Tempo Cabang Surabaya 1</td>
<td>Cabang</td>
<td></td>
<td>Jl. Rungkut Industri III No. 11, Surabay
a</td>
<td></td>
<td>Suryani Widya Oktavia, S.Farm., Apt</td>
<td>P</td>
<td>1989001/STRA-UWM/2011/26237</td>
<td></td>
<td>Stef Hermawan Iskandar</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>471</td>
<td></td>
<td>PT. Tempo Cabang Surabaya 2</td>
<td>Cabang</td>
<td></td>
<td>Jl. Gemblongan No. 73, Surabaya</td>
<td></td>
<td>Nurul Qomariyah, S.Farm., Apt</td>
<td>P</td>
<td>19831128/STRA-UNAIR/2007/27009</td>
<td></td>
<td>Wahyudi Sigit Pramono</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>472</td>
<td></td>
<td>PT. United Dico Citas</td>
<td>Cabang</td>
<td></td>
<td>Jl. Jagiran No. 76 Sby</td>
<td></td>
<td>Wulan Wiranti, S.Farm., Apt</td>
<td>P</td>
<td>KP.01.03.1.3.5893</td>
<td></td>
<td>Darmanto</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>473</td>
<td></td>
<td>PT. Antar Mitra Sembada Cabang Surabaya
1</td>
<td>Cabang</td>
<td></td>
<td>Jl. Manyar Kartika Vii No 10,12,14,16 Me

nur Pumpungan, Surabaya</td>
<td></td>
<td>Vira Natalia Chendriawan, S.Farm, Apt</t
d>
<td>P</td>
<td>KP.01.03.1.3.3375</td>
<td></td>
<td>Nelson Wijaya</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>474</td>
<td></td>
<td>PT. Bintang Utama Inti</td>
<td>Pusat</td>
<td></td>
<td>Ruko Sentra Tropodo C-25, Tropodo, Surab
aya</td>
<td></td>
Apt</td>
<td>P</td>
<td>KP.01.01.1.2.1186</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>475</td>
<td></td>
<td>PT. Indo Medipharm</td>
<td>Pusat</td>
<td></td>
<td>Jl. Raya Mastrip Kedurus Dukuh No. 62, S
urabaya</td>
<td></td>
<td>Citra Kurniasari, S.Farm, Apt</td>
<td>P</td>
<td>KP.01.03.1.3.6196</td>
<td></td>
<td>Go Andreas Sugondo</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>476</td>
<td></td>
<td>PT. Java Farma</td>
<td>Pusat</td>
<td></td>
<td>Jl. Tambak Segaran II/28, Surabaya</td>
<td></td>
<td>Yani Aristi Rini, S.Farm, Apt</td>
<td>P</td>
<td>KP.01.03.1.3.2446</td>
<td></td>
<td>Sri Andayani</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>477</td>
<td></td>
<td>PT. Kartika Global Medika</td>
<td>Pusat</td>
<td></td>
<td>Jl. Kedung Cowek No. 175, Surabaya</td>
<td></td>
<td>Ie Aries Kriestianto,Sfarm.Apt</td>
<td>P</td>
<td>KP.01.03.1.3.7936</td>
<td></td>
<td>Drs.Tiantoro Wangsadjaja</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>478</td>
<td></td>
<td>PT. Mulya Raya Petra Sejahtera</td>
<td>Pusat</td>
<td></td>
<td>Jl. Mulyosari Utara III/36-39A, Surabaya
</td>
<td></td>
<td>Diana Budiman, S.Farm, Apt</td>
<td>P</td>
<td>KP.00.03.1.3.3034</td>
<td></td>
<td>Simon Budhi Santoso R</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>479</td>
<td></td>
<td>PT. Musafa Bhakti</td>
<td>Pusat</td>
<td></td>
<td>Jl. Jagiran No. 76, Surabaya</td>
<td></td>
<td>Drs. R.Sri Dono Poernomo</td>
<td>L</td>
<td>KP.01.03.1.3.5893</td>
<td></td>
<td>Retno Setyowati</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>480</td>
<td></td>
<td>PT. Parazelsus Indonesia</td>
<td>Cabang</td>
<td></td>
a</td>
<td></td>
<td>Nico Linggi Pongmasangka, S.Farm., Apt.<
/td>
<td>L</td>
<td></td>
<td></td>
<td>Ir.Lukman</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>481</td>
<td></td>
<td>PT. Prana Keluarga Nusantara</td>
<td>Pusat</td>
<td></td>
>
<td></td>
<td>Aulia Ariestya Dewi,S. Farm.Apt</td>
<td>P</td>
<td>KP.01.03.1.3.0982</td>
<td></td>
<td>Indramurti</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>482</td>
<td></td>
<td>PT. Prima Mulia Sejahtera</td>
<td>Pusat</td>
<td></td>
<td>Jl. Taman Panjang Jiwo Permai No. 22, Su
rabaya</td>
<td></td>
<td>Nadya Rahma Wardhany, S.Farm, Apt</td>
<td>P</td>
<td>KP.01.03.1.3.1304</td>
<td></td>
<td>Tanuwidyana Lilananta</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>483</td>
<td></td>
<td>PT. Procter & Gamble Home Products Indon
esia</td>
<td>Cabang</td>
<td></td>
<td>Jl. Kalianak Barat Raya No. 66, Surabaya
</td>
<td></td>
<td>Luisa Pasadena,S.Farm,Apt</td>
<td>P</td>
<td>KP.01.03.1.3.1017</td>
<td></td>
<td>Hadi Purnomo</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>484</td>
<td></td>
<td>PT. Rajawali Nusindo Cabang Surabaya 2</

td>
<td>Cabang</td>
<td></td>
<td>Jl. Raya Tenggilis No. 101, Surabaya</td
>
<td></td>
<td>Agustina Eka Puspitasari, S.Farm, Apt</t
d>
<td>P</td>
<td>19840811/STRA-USB/2007/223842</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>485</td>
<td></td>
<td>PT. Rajawali Nusindo Cabang Surabaya 1</
td>
<td>Cabang</td>
<td></td>
<td>Jl. Kalimas Barat No. 35-37, Surabaya</t
d>
<td></td>
<td>Riza Ariesta Hellinda, S.Farm, Apt</td>
<td>P</td>
<td>19860413/STRA-UNAIR/2009/21846</td>
<td></td>
<td>Ir. Agus Suryanto</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>486</td>
<td></td>
<td>Cabang</td>
<td></td>
<td>Jl. Semut Baru Pengampon Square D-9, Sur
abaya</td>
<td></td>
<td>Sri Handayani, S.Farm, Apt</td>
<td>P</td>
<td>KP.01.03.1.3.0655</td>
<td></td>
<td>Markus</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>487</td>
<td></td>
<td>Cabang</td>
<td></td>
<td></td>
<td>Veronica Krisnawan, S.Farm., Apt</td>
<td>P</td>
<td>KP.00.03.1.3.2093</td>
<td></td>
<td>Leni</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>488</td>
<td></td>
<td>PT. Unirama Duta Niaga</td>
<td>Cabang</td>
<td></td>
>
<td></td>
<td>Dra. Elisabeth Swandayani, Apt</td>
<td>P</td>
<td></td>
<td></td>
<td>Nancy Gondobintoro</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>489</td>
<td></td>
<td>Cabang</td>
<td></td>
<td>Jl. Margorejo Indah No. 8-12, Surabaya</
td>
<td></td>
<td>Afaf Abdul Karim,Sfarm,Apt</td>
<td>L</td>
<td>KP.01.03.1.3.5857</td>
<td></td>
<td>Ng.Hoklung</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>490</td>
<td></td>
<td>Cabang</td>
<td></td>
<td>Jl. Dukuh Pakis No. 11, Surabaya</td>
<td></td>
<td>Nining Hari Murti Wijaya, S.Farm., Apt</
td>
<td>P</td>
<td>KP.01.03.1.3.2094</td>
<td></td>
<td>Mohammad Wahid</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>491</td>
<td></td>
<td>PT. Tri Tunggal Farmindo</td>
<td>Pusat</td>
<td></td>
<td>Jl. Medokan Asri Utara IX/39, Surabaya</
td>
<td></td>
<td>Maria Jessie Suprapto,S.Si,Apt</td>
<td>P</td>
<td>KP.01.01.1.3.13601</td>
<td></td>
<td>Johanes Sulistiono </td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>492</td>
<td></td>
<td>PT. Usaha Semesta Globalindo</td>
<td>Pusat</td>
<td></td>
<td>Jl. Ngagel Jaya Utara No. 2, Surabaya</t
d>
<td></td>
<td>Widha Sulistya Wulan, S.Farm., Apt.</td>
<td>P</td>
<td>KP.01.03.1.3.3714</td>
<td></td>
<td>Audia Erlangga</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>493</td>
<td></td>
<td>PT. Defina Rahmah</td>
<td>Pusat</td>
<td></td>
<td>Jl. Wisma Lidah Kulon Blok C-76, Surabay
a</td>
<td></td>
<td>Tri Udjiyanto</td>
<td>L</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>494</td>
<td></td>
<td>PT. Daya Anugrah Dewasakti</td>
<td>Pusat</td>
<td></td>
<td>Jl. Taman Jemursari Selatan I/7, Surabay
a</td>
<td></td>
<td>Galih Wahyu Prasetyo, S.Farm., Apt</td>
<td>L</td>
<td>19850325/STRA-UP/2010/14828</td>
<td></td>
<td>Moch. Noerhadi Soeyani, SH</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>495</td>
<td></td>
<td>PT. Dalan Triputra Mandiri</td>
<td>Pusat</td>
<td></td>
eks Ruko Megah Raya, Surabaya</td>
<td></td>
<td>Yunita Irwanto,Sfarm,Apt</td>
<td>P</td>
<td>KP.01.03.1.3.3380</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>496</td>
<td></td>
<td>PT. Citra Husada Madani</td>
<td>Pusat</td>
<td></td>
<td>Jl. Manyar Indah VIII/12, Surabaya</td>
<td></td>
<td>E.L.Dwi Retno Wahyuni</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>497</td>
<td></td>
<td>PT. Bima Perkasa Ikerima</td>
<td>Pusat</td>
<td></td>
<td>Jl. Barata Jaya XVIII/2, Surabaya</td>
<td></td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>498</td>
<td></td>
<td>PT. Aneka Usaha Karya Kita Koperasi</td>
<td>Pusat</td>
<td></td>
<td>Jl. Rungkut Industri Raya No. 6, Surabay
a</td>
<td></td>
<td>Harsono Irawan</td>
<td>L</td>
<td>6248/B</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>499</td>
<td></td>
<td>PT. Amadea Devina Farma</td>
<td>Pusat</td>
<td></td>
<td>Jl. Rungkut Mejoyo Utara VII Blok AD/5,
Surabaya</td>
<td></td>
<td>Ardyan Sukma Prakarsa</td>
<td>L</td>
<td>503.446/0011/SK.AA/436.4.8/O/2004</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>500</td>
<td></td>
<td>PT.Alvindo Juhan Lestari</td>
<td>Pusat</td>
<td></td>
<td>Jl. Raya Kalirungkut No. 1-3 Blok L 11-1
2, Kompleks Ruko Megah Raya, Surabaya</td>
<td></td>
<td>Henny Whardani Indrajaya</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>501</td>
<td></td>
<td>PT. Al Kahfi</td>
<td>Cabang</td>
<td></td>
<td>Jl. Ploso Baru No. 190, Surabaya</td>
<td></td>
<td>Pujiastutik</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>502</td>
<td></td>
<td>PT. Acacia Mitra Abadi</td>
<td>Cabang</td>
<td></td>
<td>Jl. Raya Panjang Jiwo Permai 1B/21, Komp
leks Pertokoan Delta Pemai Blok B-11, Surabaya</td>
<td></td>
<td>Erly Budiwati Indrarim</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>503</td>
<td></td>
<td>PT. Cendo Pratama Farma</td>
<td>Pusat</td>
<td></td>

, Surabaya</td>
<td></td>
<td>Soendayati</td>
<td>P</td>
<td>5516/B</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>504</td>
<td></td>
<td>PT. Alodia Diva Nusantara</td>
<td>Pusat</td>
<td></td>
<td>Jl. Rungkut Mejoyo Utara VII/A-5, Suraba
ya</td>
<td></td>
<td>Alif Fidias</td>
<td>L</td>
<td>21397</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>505</td>
<td></td>
<td>PT. Aryaguna Cipta Sejahtera</td>
<td>Pusat</td>
<td></td>
<td>Jl. Rungkut Kidul IV Blok I No.8, Suraba
ya</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>506</td>
<td></td>
<td>PT. Bina Artha Lestari Utama</td>
<td>Pusat</td>
<td></td>
<td>Jl. Wiguna Timur XIII/1, Surabaya</td>
<td></td>
<td>Yulistyorini Dwi U</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>507</td>
<td></td>
<td>PT. Dian Adytama Sentosa</td>
<td>Pusat</td>
<td></td>
<td>Jl. Jetis Kulon I/1, Surabaya</td>
<td></td>
<td>I Nengah Astikaa</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>508</td>
<td></td>
<td>PT. Kebayoran Pharma</td>
<td>Cabang</td>
<td></td>
<td>Jl. Gubeng Pojok No. 25, Surabaya</td>
<td></td>
<td>Suhartiningsih</td>
<td>P</td>
<td>503.446/0529/SIKAA/436.5.5/X/2008</td>
<td></td>
<td>Sukeni</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>509</td>
<td></td>
<td>PT. Anugrah Argon Medica Cabang Surabaya
2</td>
<td>Cabang</td>
<td></td>
<td>Jl. Rungkut Industri I/9C, Surabaya</td>
<td></td>
<td>Aprilliya Palupy</td>
<td>P</td>
<td>SP.KP.01.03.1.3.1905</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>510</td>
<td></td>
<td>PT. Anugrah Hasil Bersaudara</td>
<td>Pusat</td>
<td></td>
<td>Jl. Griya Kebraon Selatan 2B/24, Surabay
a</td>
<td></td>
<td>Erna M</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>511</td>
<td></td>
<td>PT. Anugerah Mitra Jaya</td>
<td>Pusat</td>
<td></td>
<td>Jl. Panjangjiwo 46-48, Ruko Panji Makmur
A-31, Surabaya</td>
<td></td>
<td>Puspa Novianti</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>512</td>
<td></td>
<td>PT. Bekasurya Perdana</td>
<td>Pusat</td>
<td></td>
<td>Jl. Penjaringan Sari II B/11, Surabaya</
td>
<td></td>
<td>Srikusrini</td>
<td>P</td>
<td>31531/Pend/AAA</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>513</td>
<td></td>
<td>PT. Aristama Andalan Mandiri</td>
<td>Pusat</td>
<td></td>
<td>Jl. Bhakti Husada III/1, Surabaya</td>
<td></td>
<td>Sudarmiyanti</td>
<td>P</td>
<td>111.6/13/SIAA</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>514</td>
<td></td>
<td>PT. Belindo Farma</td>
<td>Pusat</td>
<td></td>
<td>Jl. Raya Darmo No. 143, Surabaya</td>
<td></td>
<td>Prasetya Budiawan</td>
<td>L</td>
<td>3811/B</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>515</td>
<td></td>
<td>PT. Asita Sukses Abadi Pharmindo</td>
<td>Pusat</td>
<td></td>
<td>Jl. Medokan Ayu MA 1-A No. 1, Surabaya</
td>
<td></td>
<td>Lenny Jayanti, S.Farm., Apt</td>
<td>P</td>
<td>19860719/STRA-UNAIR/2009/22399</td>
<td></td>
<td>Eria Trisniadi</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>516</td>
<td></td>
<td>PT. Asri Pandunusa</td>
<td>Pusat</td>
<td></td>
<td>Jl. Manyar Jaya VIII/C-125, Surabaya</td
>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>517</td>
<td></td>
<td>PT. Astakarya Cipta Mandiri</td>

<td>Pusat</td>
<td></td>
<td>Jl. Barata Jaya XVIII/37</td>
<td></td>
<td>Nany Harmijanti</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>518</td>
<td></td>
<td>PT. Astro Mega Farma</td>
<td>Pusat</td>
<td></td>
<td>Jl. Kedalsari Selatan No. 16, Surabaya</
td>
<td></td>
<td>Agus Suprianto, S.Farm., Apt</td>
<td>L</td>
<td>19800829/STRA-UNAIR/2010/14951</td>
<td></td>
<td>Kliem Jo Ming</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>519</td>
<td></td>
<td>PT. Barito Budi Pharmindo</td>
<td>Pusat</td>
<td></td>
<td>Jl. Jemursari Selatan VII/20-22, Surabay
a</td>
<td></td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>520</td>
<td></td>
<td>PT. Bayaco Agung</td>
<td>Pusat</td>
<td></td>
<td>Jl. Margomulyo Industri IV Blok G No. 14
-16, Surabaya</td>
<td></td>
<td>Puspita Sariani</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>521</td>
<td></td>
<td>PT. Dian Citra Harapan</td>
<td>Pusat</td>
<td></td>
<td>Jl. Pucang Anom Timur IV/12, Surabaya</t
d>
<td></td>
<td>Adi Agung Putra</td>
<td>L</td>
<td>503.446/0005/SIK.AA/436.4.8/IV/2004</td>
<td></td>
<td>Drs. Purwo Adi Sarwono, SE, AK</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>522</td>
<td></td>
<td>PT. Distriversa Buanamas</td>
<td>Cabang</td>
<td></td>
<td>Jl. Margorejo Indah No. 28, Surabaya</td
>
<td></td>
<td>Theresia Jeannie N</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>523</td>
<td></td>
<td>PT. Anugrah Wirasatama</td>
<td>Pusat</td>
<td></td>
<td>Jl. Barata Jaya XVII/37, Surabaya</td>
<td></td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>524</td>
<td></td>
<td>PT. Bina Sarana Husada Medika</td>
<td>Pusat</td>
<td></td>
<td>Jl. Usi VII/3, Surabaya</td>
<td></td>
<td>Abdulah Halimi</td>
<td>L</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>525</td>
<td></td>
<td>PT. Cempaka Indah Murni</td>
<td>Cabang</td>
<td></td>
<td>Jl. Bibis No. 14, Surabaya</td>
<td></td>
<td>Erna Herprasetiyati</td>
<td>P</td>
<td>503.446/27393/0070/SIKAA/436.5.5/IV/2009
</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>526</td>
<td></td>
<td>PT. Catur Mandiri Farma</td>
<td>Pusat</td>
<td></td>
<td>Jl. Jemursari II/66, Surabaya</td>
<td></td>
<td>Endang Soebagjati</td>
<td>P</td>
<td>4885/B</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>527</td>
<td></td>
<td>PT. Cahaya Anugerah</td>
<td>Pusat</td>
<td></td>
<td>Jl. Bintoro No. 11, Surabaya</td>
<td></td>
<td>Sri Handayani</td>
<td>P</td>
<td>4885/B</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>528</td>
<td></td>
<td>PT. Bukit Arta Guna</td>
<td>Pusat</td>
<td></td>
<td>Kompleks Pertokoan Villa Bukit Mas Blok

RM-19,Jl. H. Abdul Wahab Siamin, Surabaya</td>
<td></td>
<td>Endah S Murdiyanti</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>529</td>
<td></td>
<td>PT. Borwita Indah</td>
<td>Pusat</td>
<td></td>
<td>Jl. Kunir No. 9, Surabaya</td>
<td></td>
<td>Like Suhermien</td>
<td>P</td>
<td>5369/B</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>530</td>
<td></td>
<td>PT. Borimex</td>
<td>Pusat</td>
<td></td>
<td>Jl. Jagir Wonokromo No. 100, Kompleks Ma
ngga Dua Blok A10 No. 1, Surabaya</td>
<td></td>
<td>Susy Handayani</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>531</td>
<td></td>
<td>PT. Bersaudara Sejahtera Utuh</td>
<td>Pusat</td>
<td></td>
<td>Ruko Segi Delapan I No. A 871, Surabaya<
/td>
<td></td>
<td>Roosyka Wahyuny,Ssi,Apt</td>
<td>P</td>
<td>SP.KP.01.01.1.2.6482</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>532</td>
<td></td>
<td>PT. Bintang Central Sakti</td>
<td>Pusat</td>
<td></td>
<td>Jl. Kebonsari Baru No. 14, Surabaya</td>
<td></td>
<td>Sabarahwati</td>
<td>P</td>
<td>SIK No.503.446/0377/36776/SIKAA/436.5.5/
VI/2009</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>533</td>
<td></td>
<td>PT. Cendikia Multi Pratama</td>
<td>Pusat</td>
<td></td>
<td>Jl. Pucang Anom Timur No. 34, Surabaya</
td>
<td></td>
<td>Ninik Setyawati</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>534</td>
<td></td>
<td>PT. Bina San Prima Cabang Surabaya 2</td
>
<td>Cabang</td>
<td></td>
<td>Jl. Rungkut Industri III/22, Surabaya</t
d>
<td></td>
<td>Diayu Desmar Dika, S.Farm., Apt</td>
<td>P</td>
<td>19860704/STRA-UBAYA/2009/21189</td>
<td></td>
<td>Doso Wuriyanto</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>535</td>
<td></td>
<td>PT. Bimala Sanjaya Megah</td>
<td>Pusat</td>
<td></td>
<td>Jl. Rungkut Mapan Tengah VIII/DG 16, Sur
abaya</td>
<td></td>
<td>Marietta Angelina Dian Soeheningsih</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>536</td>
<td></td>
<td>PT. Bhakti Persada Saudara Pharma</td>
<td>Pusat</td>
<td></td>
<td>Jl. Pucang Sewu No. 17, Surabaya</td>
<td></td>
<td>M.Djuliantono</td>
<td>L</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>537</td>
<td></td>
<td>PT. Bhakti Husada KPRI</td>
<td>Pusat</td>
<td></td>
<td>Jl. Dukuh Setro XI/2, Surabaya</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>538</td>
<td></td>
<td>PT. Bhakti Guna Sarana</td>
<td>Cabang</td>
<td></td>
<td>Jl. Gayungan PTT 57-A, Surabaya</td>
<td></td>
<td>L</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>539</td>
<td></td>
<td>PT. Beta Pharmindo Sempurna</td>
<td>Pusat</td>
<td></td>
<td>Jl. Sriwijaya No. 46, Surabaya</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>540</td>
<td></td>
<td>PT. Benzena</td>
<td>Pusat</td>
<td></td>
<td>Jl. Gembong Tebasan No. 14, Surabaya</td
>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>541</td>
<td></td>
<td>PT. Blessindo Farma</td>
<td>Pusat</td>
<td></td>
<td>Jl. Mayjen Sungkono, Kompleks Wonokitri
Indah S-33, Surabaya</td>
<td></td>
<td>Soendayanti</td>
<td>P</td>
<td>5516/B</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>542</td>
<td></td>
<td>PT. Parit Padang Global Cabang Surabaya
1</td>
<td>Cabang</td>
<td></td>
<td>Jl. Tumapel No. 10 A-12, Surabaya</td>
<td></td>
<td>Puspita Mayasari Sutanto, S.Farm., Apt</
td>
<td>P</td>
<td>19851117/STRA-UBAYA/2009/218770</td>
<td></td>
<td>Giri Saturna Bustan</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>543</td>
<td></td>
<td>PT. Millennium Pharmacon International <
/td>
<td>Cabang</td>
<td></td>
<td>Jl. Kalibokor Selatan No. 152, Surabaya<
/td>
<td></td>
<td>Wulan Nawangsari, S.Farm., Apt</td>
<td>P</td>
<td>19800920/STRA-UWM/2007/221104</td>
<td></td>
<td>Drs. Sumadi</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>544</td>
<td></td>
>
<td>Cabang</td>
<td></td>
<td>Jl. Rajawali No. 54, Surabaya</td>
<td></td>
<td>Aryati Ganefi</td>
<td>P</td>
<td></td>
<td></td>
<td>Ronald Aw Honuwo</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>545</td>
<td></td>
<td>PT. Rezeki Husada Utama</td>
<td>Pusat</td>
<td></td>
<td>Jl. Manyar Indah No. 15, Surabaya</td>
<td></td>
<td>Dra. Emma Sundrawati Tanuwijaya, Ms, Apt
</td>
<td>P</td>
<td>19520801/STRA-UNAIR/1981/214659</td>
<td></td>
<td>Iswan</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>546</td>
<td></td>
<td>PT. Indomedika Anugerah Nusantara</td>
<td>Pusat</td>
<td></td>
<td>Westwood Villa Blok AI No. 17, Pakuwon C
ity, Surabaya</td>
<td></td>
<td>Safithri Arijadi</td>
<td>P</td>
<td>111.6/13/SIAA/331/00567/III/08</td>
<td></td>
<td>Marcus Ani</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>547</td>
<td></td>
<td>PT. Datheo Pharma</td>
<td>Pusat</td>
<td></td>
<td>Jl. Raya Tenggilis No. 45-47, Surabaya</
td>
<td></td>
<td>Marlia Ariyanti, S.Farm., Apt</td>
<td>P</td>
<td>19870311/STRA-UNAIR/2012/228765</td>
<td></td>
<td>Daniel Limantara</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>548</td>
<td></td>
<td>PT. Surya Kasih</td>
<td>Pusat</td>
<td></td>
<td>Jl. Indrapura Baru No. 351 A, Lt. 2, Sur
abaya</td>
<td></td>
<td>Ambi Kuswita Rachmawati, S.Farm., Apt</t
d>
<td>P</td>
<td>19851210/STRA-UBAYA/2010/218779</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>549</td>
<td></td>
<td>PT. Rio Farma</td>
<td>Pusat</td>
<td></td>
<td>Jl. Manukan Krajan 34, Blok 31 L/6, Sura
baya</td>
<td></td>
<td>Veliana, S.Farm., Apt</td>
<td>P</td>
<td>19771016/STRA-UWM/2003/214741</td>
<td></td>
<td>Herlin Romaningsih</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>550</td>
<td></td>
<td>PT. Effata Fajar Anugerah</td>

<td>Pusat</td>
<td></td>
<td>Jl. Rungkut Asri Barat I/25, RT/RW 01/12
</td>
<td></td>
<td>Leonardus Dico Djoewarno, S.Farm., Apt</
td>
<td>L</td>
<td>19891003/STRA-UBAYA/2012/17750</td>
<td></td>
<td>Lannywati Dewi</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>551</td>
<td></td>
<td>PT. Jehovah Rafa</td>
<td>Pusat</td>
<td></td>
<td>Jl. Baratajaya XX/15 U, Surabaya</td>
<td></td>
<td>Abdul Kadir Jaelani, S.Farm., Apt</td>
<td>L</td>
<td>19740915/STRA-UBAYA/2000/10112</td>
<td></td>
<td>Dr. Fransiscus Nanga Roka</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>552</td>
<td></td>
<td>PT. Karunia Pharmindo Sejati</td>
<td>Pusat</td>
<td></td>
<td>Jl. Pacar Kembang II/109 B, Surabaya</td
>
<td></td>
<td>Wisen Yetial, S.Farm., Apt</td>
<td>L</td>
<td>19841228/STRA-UBAYA/2007/16482</td>
<td></td>
<td>Oentari Karyo Ndadari</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>553</td>
<td></td>
<td>PT. Sehat Dapat Rejeki</td>
<td>Pusat</td>
<td></td>
<td>Jl. Kembang Jepun No. 162, Surabaya</td>
<td></td>
<td>Dra. Lanywati Soedarmadji, Apt</td>
<td>P</td>
<td>19660414/STRA-UBAYA/1994/221079</td>
<td></td>
<td>Suwanto Karyono</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>554</td>
<td></td>
<td>PT. Detta Winasha</td>
<td>Pusat</td>
<td></td>
<td>Kompleks Pergudangan Meiko Abadi Blok A23, Surabaya</td>
<td></td>
<td>Liah Diah Oktora, S.Si., Apt</td>
<td>P</td>
<td>19741030/STRA-UGM/2000/218473</td>
<td></td>
<td>Winarno</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>555</td>
<td></td>
<td>PT. Gunung Sarai</td>
<td>Pusat</td>
<td></td>
<td></td>
<td>Nelchia Silvia, S.Farm., Apt</td>
<td>P</td>
<td>19801012/STRA-UBAYA/2005/225324</td>
<td></td>
<td>Sindu Rahardjo</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>556</td>
<td></td>
<td>PT. Mitra Central Asia</td>
<td>Pusat</td>
<td></td>
<td>Jl. Raya Panjang Jiwo No. 46-48, Surabay
a</td>
<td></td>
<td>Dra. Julidawati Hartono, Apt</td>
<td>P</td>
<td>19650508/STRA-UBAYA/1994/218702</td>
<td></td>
<td>David Aryanto Goenawan</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>557</td>
<td></td>
<td>PT. Pierosca Terang Sukses Abadi</td>
<td>Pusat</td>
<td></td>
<td>Jl. Darmo Permai Selatan I/5, Surabaya</
td>
<td></td>
<td>Lenny Nurcahyani, S.Farm., Apt</td>
<td>P</td>
<td>19890214/STRA-UBAYA/2012/227116</td>
<td></td>
<td>Fransiskus Budiman</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>558</td>
<td></td>
<td>PT. Anugerah Abi Farma</td>
<td>Pusat</td>
<td></td>
<td>Ruko Klampis Square Blok B-3, Surabaya</
td>
<td></td>
<td>Dra. Rina Surjani Purwadipura, M.Si., Ap

t</td>
<td>P</td>
<td>19440719/STRA-UBAYA/1992/218796</td>
<td></td>
<td>Purnama Sejati</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>559</td>
<td></td>
<td>PT. Irma Mitra Farma</td>
<td>Pusat</td>
<td></td>
<td>Jl. Baratajaya 19 No. 48 A, Surabaya</td
>
<td></td>
<td>Henny Mardiana, S.Farm., Apt</td>
<td>P</td>
<td>19820525/STRA-UNAIR/2011/24002</td>
<td></td>
<td>Djoenaidi Ingasto</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>560</td>
<td></td>
<td>PT. Surya Eka Putra</td>
<td>Pusat</td>
<td></td>
<td>Ruko Plaza Segi Delapan,Jl. Raya Darmo
Permai III Blok A-871, Surabaya</td>
<td></td>
<td>Roosyka Wahjuny, S.Si., Apt</td>
<td>P</td>
<td>19710608/STRA-UWM/2001/221144</td>
<td></td>
<td>Jongky Soerjono Noer Wonohardjo</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>561</td>
<td></td>
<td>PT. Podo Mekar Jaya Sentosa</td>
<td>Pusat</td>
<td></td>
<td>Jl. Kalisari III/17B, 15 G, D, E, F, I,
J dan 42-44, Surabaya</td>
<td></td>
<td>Ria Virdia Nita, S.Farm., Apt</td>
<td>P</td>
<td>19880908/STRA-UBAYA/2011/215704</td>
<td></td>
<td>Hutomo Wiyono</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>562</td>
<td></td>
<td>PT. Gratia Jaya Farma</td>
<td>Cabang</td>
<td></td>
<td>Jl. Kupang Indah XIX/15, Surabaya</td>
<td></td>
<td>Octy Hapsari, S.Farm., Apt</td>
<td>P</td>
<td>19851001/STRA-UBAYA/2010/218838</td>
<td></td>
<td>Sujiono, SE., MM</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>563</td>
<td></td>
<td>PT. Marga Nusantara Jaya Cabang Surabaya
1</td>
<td>Cabang</td>
<td></td>
<td>Jl. Jaksa Agung Suprapto No. 19, Surabay
a</td>
<td></td>
<td>Lisa Arianto, S.Farm., Apt</td>
<td>P</td>
<td>19870704/STRA-UWM/2010/214758</td>
<td></td>
<td>Antonius Lay</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>564</td>
<td></td>
2</td>
<td>Cabang</td>
<td></td>
<td>Jl. Berbek Industri III/17, Surabaya</td
>
<td></td>
<td>Yuliana, S.Farm., Apt</td>
<td>P</td>
<td>19881207/STRA-UBAYA/2011/222303</td>
<td></td>
<td>Kuntjoro Tedjasetiana</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>565</td>
<td></td>
3</td>
<td>Cabang</td>
<td></td>
<td>Raya Manukan Wetan No. 14, RT/RW 01/01,
Manukan Wetan, Tandes, Surabaya</td>
<td></td>
<td>Ferdi Dwi Janarto, S.Farm., Apt</td>
<td>L</td>
<td>19880509/STRA-UNAIR/2011/10994</td>
<td></td>
<td>Petrus Sutjipto Gunarta</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>2012</td>
</tr>
<tr>
<td>566</td>
<td></td>
<td>Andhi Cipta Jaya Utama, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Brawijaya No. 12 A, Banyuwangi</td>
<td></td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>567</td>
<td></td>
<td>Andika Intisurya Kusuma Farma, PT</td>
<td>Pusat</td>
<td></td>
<td>Dsn. Krajan RT/RW 01/05, Sukonator, Kec.
Srono, Banyuwangi</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>568</td>
<td></td>
<td>Sumber Gondo Perkasa, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Raya Jember Stail No. 87, Genteng, B
anyuwangi</td>
<td></td>
<td>Yeni Sintia Dewi</td>
<td>P</td>
<td>0501.896AA</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>569</td>
<td>KAB. BLITAR</td>
<td></td>
<td>Hudian Lestari Makmur, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Merdeka No. 68, Jabung Talun, Blitar
</td>
<td></td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>570</td>
<td></td>
<td>Kapas Makmur Sentosa, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Raya Kapas No. 53, Bojonegoro</td>
<td></td>
<td>Juliati</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>571</td>
<td></td>
<td>Mitra Abadi Parmindo, PT</td>
<td>Pusat</td>
<td></td>
<td>Perum Taman Sari Indah Blok J 8-9, Bondo
woso</td>
<td></td>
<td>Siti Rumaikah</td>
<td>P</td>
<td>02/SIK.AAIV/2006</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>572</td>
<td></td>
<td>Teguh Karya Raharjdo, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. A.Yani No. 8-10, Bondowoso</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>573</td>
<td></td>
<td>Berkat Kurnia Farma, PT</td>
<td>Pusat</td>
<td></td>
<td>Perum Tamansari IndahJl. Sedap Malam Bl
ok K/12, RT/RW 21/07, Tamansari, Bondowoso</td>
<td></td>
<td>Vina Kristanto, S.Farm., Apt.</td>
<td>P</td>
<td>446.6/03/APT/430.10.2/2013</td>
<td></td>
<td>Meri The Erfan</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>574</td>
<td>P-0135</td>
<td>Safari Jaya Abadi, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. KH. Zainul Arifin No. 1, Bondowoso</
td>
<td></td>
<td>Inggriany Gunawan , S.Si, Apt</td>
<td>P</td>
<td>SP. KP. 01.03.1.3.5912</td>
<td></td>
<td>HENI RAHMAWATI,S.Pd</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>575</td>
<td>P-1918</td>
<td>Mawar Abadi Pharmindo, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Letjend. Soeprapto No. 81, Bondowoso
</td>
<td></td>
<td>Melisa, S. Farm, Apt</td>
<td>P</td>
<td>SP. Kp. 01,03,1,3,4044</td>
<td></td>
<td>NINIK</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>576</td>
<td>P-0626</td>
<td>Bintang Pramesti Utama, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Kalimantan 45 Kav 51, GKB, Gresik</t
d>
<td></td>
<td>Yulian Eka Kusuma, S.Farm., Apt.</td>
<td>P</td>
<td>19850719/STRA-UWM/2011/26205</td>
<td></td>
<td>Nining Henik Intarti</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>577</td>
<td></td>
<td>Sumber Baru Megafarma, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. M. Yamin No. 69, Jember</td>
<td></td>
<td>Amelia Setiarini,Ssi,Apt</td>
<td>P</td>
<td>KP.01.03.1.3.1106</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>578</td>
<td></td>
<td>Perusahaan Perdagangan Indonesia, PT</td
>
<td>Cabang</td>
<td></td>
<td>Jl. PB Sudirman No. 71, Jember</td>
<td></td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>579</td>
<td></td>
<td>Sapta Sari Tama, PT</td>
<td>Cabang</td>
<td></td>
<td></td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>580</td>
<td></td>
<td>Sahabat Insan Medika, PT</td>
<td>Pusat</td>
<td></td>
<td></td>
<td>Lindiawati Dwi A</td>
<td>P</td>
<td>0501871.AA</td>
<td></td>
<td>Dree Rhomaniyani</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>581</td>
<td></td>
<td>Rejeki Mitra Farma, PT</td>
<td>Cabang</td>
<td></td>
<td>Jl. Hayam Wuruk No. 191, Jember</td>
<td></td>
<td>P</td>
<td>440/018/436.317/2006</td>
<td></td>
<td>Samuel Iskandar</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>582</td>
<td></td>
<td>Omni Megajasa Indoprima, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Wolter Monginsidi No. 60/99, Jember<
/td>
<td></td>
<td>Ester Tieneke</td>
<td>P</td>
<td>6719/B</td>
<td></td>
<td>Hendricus Fianto</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>583</td>
<td></td>
<td>Mitra Pharmindo Sejati, PT</td>

<td>Pusat</td>
<td></td>
<td>Jl. Kertanegara 165/25, Jember</td>
<td></td>
<td>Heni Fajar Suryawati</td>
<td>P</td>
<td>0501822.AA</td>
<td></td>
<td>Mochammad Rosul</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>584</td>
<td></td>
<td>Masamedi Inti Farmindo, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Sutoyo No. 45, Jember</td>
<td></td>
<td>Fitriyah</td>
<td>P</td>
<td>440/152/436.317/VII/2008</td>
<td></td>
<td>Sutarno</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>585</td>
<td></td>
<td>Lizmulti Usaha, PT</td>
<td>Pusat</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>586</td>
<td></td>
<td>Koperasi Karyawan Alamanda, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Citarum No. 21, Jember</td>
<td></td>
<td>Yulis Wulandari</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>587</td>
<td></td>
<td>Indofarma Global Medika, PT</td>
<td>Cabang</td>
<td></td>
<td>Jl. Imam Bonjol No. 37, Kaliwates, Jembe
r</td>
<td></td>
<td>Silfiana Nisa Permatasari, S.Farm., Apt.
</td>
<td>P</td>
<td>19890623/STRA-UWM/2012/230035</td>
<td></td>
<td>Muchamad Syukri</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>588</td>
<td></td>
<td>Borsumij Wehry Indonesia, PT</td>
<td>Cabang</td>
<td></td>
<td></td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>589</td>
<td></td>
<td>Indofarma Husada Sehat, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Karimata IV/20, Jember</td>
<td></td>
<td>Inge Maeeinda Prihartini</td>
<td>P</td>
<td>440/011/436.317/2006</td>
<td></td>
<td>Ir. Mahfudi Husodo</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>590</td>
<td></td>
<td>Indorukma Setiajaya, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Samanhudi No. 88 A, Jember</td>
<td></td>
<td>Dedy Prishatowo</td>
<td>L</td>
<td></td>
<td>Setawan</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>591</td>
<td>P-0029</td>
<td>Bina San Prima, PT</td>
<td>Cabang</td>
<td></td>
<td>Jl. Letjen Sutoyo No. 138, RT/RW 02/03,
Kec. Kranjingan, Jember</td>
<td></td>
<td>Ika Nursiana,S.Farm.,Apt</td>
<td>P</td>
<td>19850505/SIKA_35.09/2012/2008</td>
<td></td>
<td>Suyanta</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>592</td>
<td>P-0115</td>
<td>Anugrah Argon Medica, PT</td>
<td>Cabang</td>
<td></td>
<td></td>
<td>Ach. Riyadi, S.Farm., Apt</td>
<td>L</td>
<td>19840706/STRA-USB/2010/16726</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>593</td>
<td>P-0198</td>
<td>Sakajaja Makmur Abadi, PT</td>
<td>Cabang</td>
<td></td>
<td>Jl. Mojopahit Blok Y No. 8, Kaliwates, J
ember</td>
<td></td>
<td>Widya Ari Sukmawati, S.Farm., Apt</td>
<td>P</td>
<td>19850111/SIK-35.09/2011/2002</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>594</td>
<td>P-0253</td>
<td>Enseval Putera Megatrading Tbk, PT</td>
<td>Cabang</td>
<td></td>
<td>Jl. Wolter Monginsidi No. 889, Rowo Inda
h Ajung, Jember</td>
<td></td>
<td>Fahmi Ulfi, S.Farm., Apt</td>
<td>L</td>
<td>19870704/SIKA_35.09/2011/1003</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>595</td>
<td>P-0444</td>
<td>Penta Valent, PT</td>
<td>Cabang</td>
<td></td>
<td>Jl. Imam Bonjol No. 6, Kaliwates, Jember
</td>
<td></td>
<td>Febrian Wahyu Mushonnifa S,Farm.Apt</td>
<td>L</td>
<td>19860212/SIKA_35.09/2012/2014</td>
<td></td>
<td>Arif Rahman Hakim</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>596</td>
<td>P-0460</td>
<td>Anugrah Pharmindo Lestari, PT</td>
<td>Cabang</td>
<td></td>
<td>Jl. Letjen Sutoyo No. 138, Kel Kranjinga
n, Kec. Sumbersari, Jember</td>
<td></td>
<td>Dian Anggraini,S.Farm.,Apt</td>
<td>P</td>
<td>19850303/STRA-UII/2011/26258</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>597</td>
<td>P-0495</td>
<td>Pharmindo Rimpang Kokoh, PT</td>
<td>Cabang</td>
<td></td>
<td></td>
<td>MaeAtul Hasanah</td>
<td>P</td>
<td>440/016/436.317/2005</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>598</td>
<td>P-0496</td>
<td>Rajawali Nusindo, PT</td>
<td>Cabang</td>
<td></td>
<td>Jl. Tawang Mangu No. 131 A, Jember</td>
<td></td>
<td>Rio Dedi Pranoto S.Farm., Apt</td>
<td>L</td>
<td>19870114/STRA-UNUD/2011/11242</td>
<td></td>
<td>Satrio Budi Utomo</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>599</td>
<td>P-0500</td>
<td>Supra Usadhatama, PT</td>
<td>Cabang</td>
<td></td>
<td>Jl. Teuku Umar No. 87, Tegal Besar, Kali
wates, Jember</td>
<td></td>
<td>Ummul Mursidah, S.Farm.,Apt</td>
<td>P</td>
<td>19870905/SIKA_35.09/2011/2001</td>
<td></td>
<td>Sugiantoro</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>600</td>
<td>P-0582</td>
<td>Dos Ni Roha, PT</td>
<td>Cabang</td>
<td></td>
td>
<td></td>
<td>Dyah Suci Nurani, S.Farm., Apt.</td>
<td>P</td>
<td>19870122/STRA-UNUD/2011/24808</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>601</td>
<td>P-0597</td>
<td>Merapi Utama Pharma, PT</td>
<td>Cabang</td>
<td></td>
<td></td>
<td>Ade Zona Akhirita Junjungan, S.Farm.,Apt
</td>
<td>L</td>
<td>19861226/SIKA_35.09/2012/2018</td>
<td></td>
<td>M. Daniel Dianugrah Mitak</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>602</td>
<td>P-0698</td>
<td>Farmahusada Millenia, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Srikoyo I/7, Jember</td>
<td></td>
<td>Andri Astuti, S.Farm., Apt</td>
<td>P</td>
<td>19801010/STRA-UNAIR/2007/214911</td>
<td></td>
<td>Udi</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>603</td>
<td>P-0744</td>
<td>Kebayoran Pharma, PT</td>
<td>Cabang</td>
<td></td>
<td></td>
<td>Maulidia Rahmani, S.Farm., Apt.</td>
<td>P</td>
<td>19881130/STRA-ITB/2011/26560</td>
<td></td>
<td>Roby Wibowo, S.Ikom.</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>604</td>
<td>P-0819</td>
<td>Millennium Pharmacon International, PT</
td>
<td>Cabang</td>
<td></td>
<td>Jl. Kertanegara No. 210, Jember</td>
<td></td>
<td>Dewi Rahmawati, S.Farm., Apt</td>
<td>P</td>
<td>19870408/STRA-UMS/2009/221348</td>
<td></td>
<td>Suwoto</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>605</td>
<td>P-1130</td>
<td>Mensa Bina Sukses, PT</td>
<td>Cabang</td>
<td></td>
<td>Jl. KH. Shiddiq No. 110, Jember Kidul, K
aliwates, Jember</td>
<td></td>
<td>Ika Dewi Manesti, S.Farm., Apt.</td>
<td>P</td>
<td>19830317/STRA-UNAIR/2006/221346</td>
<td></td>
<td>Pamuji</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>606</td>
<td>P-1333</td>
<td>Antar Mitra Sembada, PT</td>
<td>Cabang</td>
<td></td>
<td></td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>607</td>
<td>P-1390</td>
<td>Tempo, PT</td>
<td>Cabang</td>
<td></td>
<td></td>
<td>Riang Pramulia, S.Farm., Apt.</td>
<td>P</td>
<td>19890818/SIKA_35.09/2013/2029</td>
<td></td>
<td>Mochammad Hasmi Azhari</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>608</td>
<td>P-1491</td>
<td>Marga Nusantara Jaya, PT</td>
<td>Cabang</td>
<td></td>

td>
<td></td>
<td>Ike Nur Fitriana, S.Farm., Apt</td>
<td>P</td>
<td>19890507/STRA-UNAIR/2011/24014</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>609</td>
<td>P-1762</td>
<td>Atmosfer Khatulistiwa Pratama, PT</td>
<td>Pusat</td>
<td></td>
<td>Perum Bumi Tegal Besar Blok AA-8, Jember
</td>
<td></td>
<td>Aisyah Rohmatullah, S.Farm., Apt</td>
<td>P</td>
<td>19880616/STRA-UNAIR/2012/225596</td>
<td></td>
<td>Muhammad Asyhari Bungah</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>610</td>
<td>P-0199</td>
<td>Cabang</td>
<td></td>
<td>Jl. Yos Sudarso No. 48 B, Jombang</td>
<td></td>
<td>Victa Elshera Pradana, S.Farm.Apt</td>
<td>P</td>
<td>KP. 01.03.1.3.3245</td>
<td></td>
<td>Sutadji</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>611</td>
<td>P-0534</td>
<td>Tempo, PT</td>
<td>Cabang</td>
<td></td>
<td>Jl. Mataram No. 176, Kediri</td>
<td></td>
<td>Dina Mariani.S.Farm,Apt</td>
<td>P</td>
<td>19850320/STRA-UNAIR/2009/215309</td>
<td></td>
<td>Mochamad Sofyan</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>612</td>
<td>P-1070</td>
<td>Cabang</td>
<td></td>
<td></td>
<td>Eko Siswanto, S.Farm., Apt</td>
<td>L</td>
<td>19870526/STRA-USB/2011/10572</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>613</td>
<td></td>
<td>Cabang</td>
<td></td>
<td>Jl. Raya Tiron No. 64, Nglames, Madiun</
td>
<td></td>
<td>Lanawati</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>614</td>
<td>P-0194</td>
<td>Cabang</td>
<td></td>
<td></td>
<td>Ruly Jayanti, S.Farm., Apt</td>
<td>P</td>
<td>KP.01.03.1.3.3343</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>615</td>
<td>P-0476</td>
<td>Cabang</td>
<td></td>
<td></td>
<td>Ainul Rodiyah S.Si,Apt.</td>
<td>P</td>
<td>19761029/SIKA_35.19/2012/2004</td>
<td></td>
<td>Nanang Arvianto</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>616</td>
<td>P-1483</td>
<td>Cabang</td>
<td></td>
<td>Jl. Raya Solo No. 154, Jiwan, Madiun</td
>
<td></td>
<td>Sri Prihatiningsih, S.Farm., Apt</td>
<td>P</td>
<td>19870312/STRA-USB/2011/22509</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>617</td>
<td>KAB. MAGETAN</td>
<td></td>
<td>Akbar Jaya Farma, PT</td>
<td>Pusat</td>
<td></td>
<td>Ds. Manjung RT/RW 01/01, Magetan</td>
<td></td>
<td>Yetti Hariningsih, S.Farm., Apt</td>
<td>P</td>
<td>19790119/STRA-USB/2004/220592</td>
<td></td>
<td>Kardjo</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>618</td>
<td></td>
<td>Kinarya Jaya Abadi, PT</td>
<td>Pusat</td>
<td></td>
<td>Dusun Krajan RT/RW 09/07, Desa Bunut Wet
an, Kec. Pakis, Malang</td>
<td></td>
<td>Reny Pratiwi,S.Farm,Apt</td>
<td>P</td>
<td>19860424/STRA-UBAYA/2010/222560</td>
<td></td>
<td>Miftakhul Hidayat</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>619</td>
<td></td>
<td>Andhika As Syifak, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Raya Kauman No. 107, RT/RW 13/10, Ds
. Tumpang, Kec. Tumpang, Malang</td>
<td></td>
<td>Masita Rinaldia, S.Farm., Apt.</td>

<td>P</td>
<td>19880309/STRA-UAD/2011/24121</td>
<td></td>
<td>Hj. Susilowati</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>620</td>
<td></td>
<td>Cabang</td>
<td></td>
<td>Jl. Mondoroko No. 169 A, Pagentan, Singo
sari, Malang</td>
<td></td>
<td>Revi Oktaviana, S.Farm., Apt.</td>
<td>P</td>
<td>19891011/STRA-ITB/2012/229235</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>621</td>
<td></td>
<td>Fitalab Utama Karya, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Karanglo Blok B1 RT/RW 03/04, Banjar
arum, Singosari, Malang</td>
<td></td>
<td>Yuliana Pravitasari, S.Farm., Apt.</td>
<td>P</td>
<td>19880723/STRA-UGM/2011/228385</td>
<td></td>
<td>Budi Utama Joesoef</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>622</td>
<td></td>
<td>Damai Sejahtera Pharma, PT</td>

<td>Pusat</td>
<td></td>
<td>Jl. Kertanegara No. 87, Karangploso, Mal
ang</td>
<td></td>
<td>Badaruzzaman Hafidz Wasla, S.Farm., Apt.
</td>
<td>L</td>
<td>19880314/STRA-UNAIR/2013/18841</td>
<td></td>
<td>Yulias Dwi Putra</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>623</td>
<td>P-0392</td>
<td>Cabang</td>
<td></td>
<td>Jl. Industri No. 90, RT/RW 03/01, Ds. Ma
ngliawan Pakis, Malang</td>
<td></td>
<td>Titi Irmawati, S.Farm., Apt.</td>
<td>P</td>
<td>19880503/STRA-UAD/2013/231027</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>624</td>
<td>P-0527</td>
<td>Tri Sapta Jaya, PT</td>
<td>Cabang</td>
<td></td>
<td>Jl. Raya Karanglo No.73 A, RT/RW 03/04,
Banjararum, Singosari, Malang</td>
<td></td>
<td>Utami Puji Rahayu Fransisca, S.Farm., Ap
t.</td>
<td>P</td>
<td>19830802/SIKA_35.07/2013/2028</td>
<td></td>
<td>Andry Mulia Sirait</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>625</td>
<td>P-0627</td>
<td>Nusa Sari Pharma, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Anusapati No. 59, Singosari, Malang<
/td>
<td></td>
<td>Ahmad Fajar Nata Atmaja, S.Farm., Apt.</
td>
<td>L</td>
<td>19870630/STRA-USB/2013/18991</td>
<td></td>
<td>Sukarno</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>626</td>
<td></td>
<td>Mega Karya Indonesia Jaya, PT</td>
<td>Pusat</td>
<td></td>
<td>Perum Nyalabu Indah Blok D No. 1, Pameka
san</td>
<td></td>
<td>Novi Hidayati</td>
<td>P</td>
<td></td>
<td>Ir. Agus Kasiyanto, SH.,MH.</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>627</td>
<td>P-0535</td>
<td>Seles Global Farma, PT</td>
<td>Pusat</td>
<td></td>
<td>Dsn Talun 03/03, Desa Gunung Gangsil, Pa
suruan</td>
<td></td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>628</td>
<td>P-1528</td>
<td>Cahaya Meyza Putra Sentosa, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Cindewilis No. 2 A, Ponorogo</td>
<td></td>
<td>Dewi Anggraeni, S.Farm., Apt</td>
<td>P</td>
<td>19871114/STRA-UII/2011/26255</td>
<td></td>
<td>Merry Yussnita, S.Si., Apt</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>629</td>
<td>P-1848</td>
<td>Mentari Indah Permai, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Janoko No. 53, Ponorogo</td>
<td></td>
<td>Umi MarAtul Sholichah</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>630</td>
<td></td>
<td>Osadha Graha Sejahtera, PT</td>
<td>Cabang</td>
<td></td>

<td></td>
<td>P</td>
<td>19871119/STRA-UMS/2011/28601</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>631</td>
<td></td>
<td>Nusasari Dinamika, PT</td>
<td>Pusat</td>
<td></td>
<td>Ruko Kedungturi Blok A-4,Jl. Kedungturi
No. 33, Sepanjang, Sidoarjo</td>
<td></td>
<td>Dewi Indria Safitri</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>632</td>
<td></td>
<td>Maxindo Health Perkasa, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Raya Sedati Agung No. 27, Sidoarjo</
td>
<td></td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>633</td>
<td></td>
<td>Lelela Bhakti Utama, PT</td>
<td>Pusat</td>
<td></td>
<td>Ruko Deltasari Indah AN/8, Sidoarjo</td>
<td></td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>634</td>
<td></td>
<td>Kanigoro Indah Perkasa, PT</td>
<td>Pusat</td>
<td></td>
<td>Pertokoan Taman Jenggolo Mas Blok B-15Jl
. Sunandar Priyo Sudarmo, Sidoarjo</td>
<td></td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>635</td>
<td></td>
<td>Imar Karya Tama, PT</td>
<td>Pusat</td>
<td></td>
<td>Perum Griya Bhayangkara Blok B3/10, Masa
ngan Kulon, Sukodono, Sidoarjo</td>
<td></td>
<td>Wiendah Hamidah, S.Si., Apt.</td>
<td>P</td>
<td>1977/1026/SIKA_3515/2013/2018</td>
<td></td>
<td>Aris Wahyudi</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>636</td>
<td></td>
<td>Gatra Persada, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Sambisari Kav. Utara Blok F No. 6,Ta
man, Sidoarjo</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>637</td>
<td></td>
<td>Cabang</td>
<td></td>
<td>Jl. A.Yani No. 41-43. Kompleks Pergudang
an Central Square Blok E 5, Gedangan, Sidoarjo</td>
<td></td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>638</td>
<td></td>
<td>Dua Sekawan Sejahtera, PT</td>
<td>Pusat</td>
<td></td>
<td>Perum Pondok Jati II Blok A/28, Sidoarjo
</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>639</td>
<td></td>
<td>Delta Intan Mandiri, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Delta Puspa No. 147, Waru, Sidoarjo<
/td>
<td></td>
<td>Erwina Kurniawati, S.Farm, Apt</td>
<td>P</td>
<td></td>
<td></td>
<td>Mochamad Asmanu</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>640</td>
<td></td>
<td>Daya Muda Agung, PT</td>
<td>Cabang</td>
<td></td>
<td>Jl. Nangka No. 265, Desa Sruni Gedangan<
/td>
<td></td>
<td>Welky Alfianto, S.Farm., Apt</td>
<td>L</td>
<td>19890325/SIKA_3515/2013/1020</td>
<td></td>
<td>Sugeng Pribadi</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>641</td>
<td></td>
<td>Citra Mandiri Farmatama, PT</td>
<td>Cabang</td>
<td></td>
<td></td>
<td>Djamilah</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>642</td>
<td></td>
<td>Buwana Nugroho Lestari, PT</td>
<td>Pusat</td>
<td></td>
<td>Perum Magersari Permai Blok J-12, Sidoar
jo</td>
<td></td>
<td>L</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>643</td>
<td></td>
<td>Borwita Citra Prima, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Raya Taman No. 48 A, Taman, Sidoarjo
</td>
<td></td>
<td>Shierly Regina P</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>644</td>
<td></td>
<td>Cabang</td>
<td></td>
<td>Jl. Raya Waru No. 44, Waru, Sidoarjo</td
>
<td></td>
<td>L</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>645</td>
<td></td>
<td>Bintang Fajar Jaya Bersama, PT</td>
<td>Pusat</td>
<td></td>
<td>Perum Permata Sukodono Raya Blok C-1 No.
34, Sidoarjo</td>
<td></td>
<td>Arie Widyani</td>
<td>P</td>
<td></td>
<td></td>
<td>Mujito</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>646</td>
<td></td>
<td>Bangkit Husada Farma, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Delta Sari Indah BE-17, Sidoarjo</td
>
<td></td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>647</td>
<td></td>
<td>Abirawa Setia Sejahtera, PT</td>
<td>Pusat</td>
<td></td>
<td>Delta Sari Indah AX-14, Sidoarjo</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>648</td>
<td></td>
<td>Andhika Mitra Serasi, PT</td>
<td>Pusat</td>
<td></td>
<td>Ruko Pondok ChandraJl. Palem ITC-15, Si
doarjo</td>
<td></td>
<td>Kariyati</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>649</td>
<td></td>
<td>Permata Delta Agung, PT</td>
<td>Pusat</td>
<td></td>
<td>Perum Pesona Permata Gading C-14, Sidoar
jo</td>
<td></td>
<td>Didit Eka Permana S.Farm., Apt</td>
<td>L</td>
<td>19860627/STRA-UNAIR/2011/11008</td>
<td></td>
<td>Agung Kurniawan</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>650</td>
<td></td>
<td>Richtji, PT</td>
<td>Cabang</td>
<td></td>
<td>Jl. Nanas VII No. 679, Pondok Candra, Si
doarjo</td>
<td></td>
<td>P</td>
<td>0502.1733.AA</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>651</td>
<td></td>
<td>Cabang</td>
<td></td>
No. 10-12, Sidoarjo</td>
<td></td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>652</td>
<td></td>
<td>Cabang</td>
<td></td>
<td>Jl. Raya Buncitan No. 1A, Sedati Juanda,
Sidoarjo</td>
<td></td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>653</td>
<td></td>
<td>Perdana Anugrah Sejahtera, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Delta Raya Selatan No. 45 (Deltasari
Baru), Sidoarjo</td>
<td></td>
<td>P</td>
<td>0501.831.AA</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>654</td>
<td></td>
<td>Tiara Rucita Pharmindo, PT</td>
<td>Pusat</td>
<td></td>
<td>Ruko Taman Aloha No. 6 (Lantai 2)</td>
<td></td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>655</td>
<td></td>
<td>Solaris Multi Abadi, PT</td>
<td>Pusat</td>
<td></td>
<td>Kompleks Pergudangan West Gade Diamond B
lok B-9, Wedi Gedangan, Sidoarjo</td>
<td></td>
<td>Erlena Jauwri, S,Farm.Apt</td>
<td>P</td>
<td>KP.01.03.1.3.4363</td>
<td></td>
<td>Pawit</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>656</td>
<td></td>
<td>Sinar Niaga Sejahtera, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Ngelom Megare No. 573, Sidoarjo</td>
<td></td>
<td>Rachmawati Fitria</td>
<td>P</td>
<td>503.445/0158/SIKAA/436.5.5/VI/2006</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>657</td>
<td>P-0075</td>
<td>Sun Hodos, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Taruna No. 217, Wage, Sidoarjo</td>
<td></td>
<td>Petrus Mikhael Rusli Odja, S.Farm., Apt.
</td>
<td>L</td>
<td>19860126/STRA-USB/2012/18521</td>
<td></td>
<td>Setiabudi, ST</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>658</td>
<td>P-0092</td>
<td>Bintang Utama Inti Medika, PT</td>
<td>Pusat</td>
<td></td>
<td>Ruko Sentra Tropodo C-25, Raya Tropodo N
o. 115, Sidoarjo</td>
<td></td>
Apt</td>
<td>P</td>
<td>KP.01.03.1.3.4081</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>659</td>
<td>P-0136</td>
<td>Insan Indofarma, PT</td>
<td>Pusat</td>
<td></td>
<td>Kompleks Industri dan Pergudangan Sinar
Buduran Blok A Kav No. 3, Buduran, Sidoarjo</td>
<td></td>
<td>Diky Erdiyono S.Farm., Apt</td>
<td>L</td>
<td></td>
<td></td>
<td>Djonny Taslim</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>660</td>
<td>P-0166</td>
<td>Cabang</td>
<td></td>
/td>
<td></td>
<td>Reny Kusuma Wardani, S.Farm., Apt.</td>
<td>P</td>
<td>19890526/SIKA_3515/2013/2024</td>
<td></td>
<td>Sarwono</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>661</td>
<td>P-0188</td>
<td>Alamanda Medica Farma, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Jatisari Permai I/D4, Wisma Permai B
ungurasih, Waru, Sidoarjo</td>
<td></td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>662</td>
<td>P-0276</td>
<td>Bina Mitra Jaya Bersama, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Raya Waru, Ruko Gateway A 36-37, Sid
oarjo</td>
<td></td>
<td>Yohans Putra Pramana, S.Farm., Apt.</td>
<td>L</td>
<td>19870330/SIIKA_3515/2012/1060</td>
<td></td>
<td>Felix Wiyono</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>663</td>
<td>P-0516</td>
<td>Cabang</td>
<td></td>
<td>Jl. Palm 2 Blok TD No. 23, Pondok Candra
<td></td>
<td>Silmi Diana, S.Farm., Apt.</td>
<td>P</td>
<td>19880705/SIKA_3515/2013/2002</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>664</td>
<td>P-0536</td>
<td>Enseval Putra Megatrading Tbk Cabang Sur
abaya 1, PT</td>
<td>Cabang</td>
<td></td>
<td>Jl. Berbek Industri VII No. 8-10, Sidoar
jo</td>
<td></td>
<td>Fatimatus Zahroh, S.Farm., Apt</td>
<td>P</td>
<td>19840222/STRA-UBAYA/2007/218507</td>
<td></td>
<td>Henry Sudarto</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>665</td>
<td>P-0539</td>
<td>Cabang</td>
<td></td>
Nila Alam 10/12, Sidoarjo</td>
<td></td>
<td>I.Gusti Ayu Prasanthy Suweda,Sfarm,Apt</
td>
<td>P</td>
<td>19851024/DTRA-UBAYA/2009/219060</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>666</td>
<td>P-0562</td>
<td>Medinarofa Karya Yasa, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Nakula E-12, Griya Sedati Indah, Sid
oarjo</td>
<td></td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>667</td>
<td>P-0577</td>
<td>Tri Sapta Jaya, PT</td>
<td>Cabang</td>
<td></td>
<td>Ruko Gateway Blok F No. 10-12, Sidoarjo<
/td>
<td></td>
<td>Nur Madusari,Sfarm.Apt</td>
<td>P</td>
<td>19830218/SIKA_3515/2013/2025</td>
<td></td>
<td>Liem Wie Yong</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>668</td>
<td>P-0612</td>
<td>Sativa Graha Farma, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Blimbing II No. 83, Pondok Candra, S
idoarjo</td>
<td></td>
<td>Octavian Hari Susanto, S.Si., Apt</td>
<td>L</td>
<td>KP.01.01.3.02558</td>
<td></td>
<td>Dra. Sufaria</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>669</td>
<td>P-0621</td>
<td>Indositra Utama, PT</td>
<td>Pusat</td>
<td></td>
<td>Perum Taman Pondok Jati Blok AY No. 6, S
idoarjo</td>
<td></td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>670</td>
<td>P-0660</td>
<td>San Prima Sejati, PT</td>
<td>Cabang</td>
<td></td>
<td>Jl. Rajawali No. 31, Rewin, Waru, Sidoar
jo</td>
<td></td>
<td>Ayu Menik Ariyanti, S.Si., Apt</td>
<td>P</td>
<td>19790619/STRA-UNAIR/2004/227367</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>671</td>
<td>P-0906</td>
<td>Dempo Sentosa, PT</td>
<td>Cabang</td>
<td></td>

, Sidoarjo</td>
<td></td>
<td>Hendrik, S.Farm., Apt.</td>
<td>L</td>
<td>19880618/STRA-UWM/2012/17867</td>
<td></td>
<td>Ronnijanto Tanuhadi</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>672</td>
<td>P-1549</td>
<td>Kimia Farma Trading & Distribution, PT</
td>
<td>Cabang</td>
<td></td>
<td></td>
<td>Rudi Syahrial, S.Farm., Apt</td>
<td>L</td>
<td>19840422/STRA-UNAND/2008/10665</td>
<td></td>
<td>Drs. Budi Asmono, Apt.</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>673</td>
<td>P-1629</td>
<td>Forta Mitra Sejati, PT</td>
<td>Cabang</td>
<td></td>
<td>Jl. Raya Wisma Tropodo AC-8, Sidoarjo</t
d>
<td></td>
<td>Sarimurti Dewi A</td>
<td>P</td>
<td>442/III.5/5023B/2003</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>674</td>
<td>P-1890</td>
<td>Sedati Gunung Mulia, PT</td>
<td>Pusat</td>
<td></td>
<td>Kompleks Pergudangan Maiko Abadi Blok A23, Wedi Gedangan, Sidoarjo</td>
<td></td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>675</td>
<td>P-0357</td>
<td>Gentha Berlian, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Masalembu III/, Sumenep</td>
<td></td>
<td>Eko Kristanto, S.Farm., Apt</td>
<td>L</td>
<td>19870516/STRA-UNAIR/2010/17514</td>
<td></td>
<td>Drs. Abdurrachmad Amar</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>676</td>
<td>P-1698</td>
<td>Gentha Raya, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Slamet Riadi No. 9, Pabian, Sumenep<
/td>
<td></td>
<td>Nur Komariah, S.Farm., Apt</td>
<td>P</td>
<td>19870205/STRA-UNAIR/2011/214672</td>
<td></td>
<td>Moh. Saleh</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>677</td>
<td></td>
<td>Pusat</td>
<td></td>
<td>Jl. K.H. Agus Salim 11 Blok A 24-25, Tul
ungagung</td>
<td></td>
<td>Wiwin Widyawati</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>678</td>
<td></td>
<td>Agung Yasa Husada, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Teuku Umar No. 88, Tulungagung</td>
<td></td>
<td>Ismiati, Amd</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>679</td>
<td></td>
<td>Sinergi Distribusi Utama, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Moh. Yamin No. 108, Tulungagung</td>
<td></td>
<td>Esti Rahayuningsih, S.Farm, Apt</td>
<td>P</td>
<td></td>
<td>Hariadi</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>680</td>
<td>KOTA BATU</td>
<td></td>
<td>Mas Rose Citra Abadi, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Raya Gangsiran Wetan No. 9 RT/RW 01/
03, Ds. Tlekung, Kec. Junrejo, Batu</td>
<td></td>
<td>Hesti Rahma Handadari, S.Farm., Apt.</td
>
<td>P</td>
<td>19850413/SIKA_35.79/2013/2001</td>
<td></td>
<td>Drs. M. Rosyidi Ims, MM</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>681</td>
<td>KOTA BATU</td>
<td>P-0555</td>
<td>Indokarya Asifa, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Raya Sumbergondo No. 1 RT/RW 02/01,
Ds. Sumbergondo, Kec. Bumiaji, Batu</td>
<td></td>
<td>P</td>
<td></td>
<td>Isfahani, S.H</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>682</td>
<td></td>
<td>Bhakti Usaha Purna Wira, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Dandangan III/28, Kediri</td>
<td></td>
<td>Sektyowati</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>683</td>
<td></td>
<td>Kallista Prima, PT</td>
<td>Cabang</td>
<td></td>
<td></td>
<td>Anistisia Frina Dinarsari, S.Farm., Apt<
/td>
<td>P</td>
<td>19860731/STRA-UNAIR/2010/218138</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>684</td>
<td></td>
<td>Bahtera Talenta Jaya, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Semeru No. 182, Kediri</td>
<td></td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>685</td>
<td></td>
<td>Lestari Jaya Farma, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Dr. Sutomo No. 54, Kediri</td>
<td></td>
<td>Dian Pratiwi Widjaya, S.Farm, Apt</td>
<td>P</td>
<td>KP.01.03.1.3.1640</td>
<td></td>
<td>Aniek Suryani</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>686</td>
<td></td>
<td>Doho Nauli, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Dandangan II/14, Kediri</td>
<td></td>
<td>Agnis Shinta Prawesti, S.Farm., Apt.</td
>
<td>P</td>
<td>19850829/STRA-UBAYA/2011/215657</td>
<td></td>
<td>Renni Kholan</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>687</td>
<td>P-0021</td>
td>
<td>Cabang</td>
<td></td>
<td>Jl. Brigjen Katamso No. 80, Kediri</td>
<td></td>
<td>L</td>
<td>446/916/419/412004</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>688</td>
<td>P-0193</td>
<td>Cabang</td>
<td></td>
<td>Jl. Gatot Subroto No. 153, Kediri</td>
<td></td>
<td>Lisa Iriani., S.Farm, Apt</td>
<td>P</td>
<td>19861019/STRA-USB/2011/22466</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>689</td>
<td>P-0213</td>
<td>Daya Manunggal, PT</td>
<td>Pusat</td>
<td></td>
<td></td>
<td>Simuarsih</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>690</td>
<td>P-0318</td>
<td>Cabang</td>
<td></td>
<td>Jl. Slamet Riadi No. 16, Banjaran, Kedir
i</td>
<td></td>
<td>Mulyani, S.Farm., Apt</td>
<td>P</td>
<td>19870626/SIKA-35.71/2012/2007</td>
<td></td>
<td>Jarot Santoso</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>691</td>
<td>P-0387</td>
<td>Tinalan Andatu Lestari, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. B. Pol. Ibh. Pranoto No. 11 A, Kedir
i</td>
<td></td>
<td>Imelda Agustina Cahyono, S.Farm., Apt</t
d>
<td>P</td>
<td>19820827/STRA-UWM/2007/214942</td>
<td></td>
<td>Teddy Saputra</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>692</td>
<td>P-0410</td>
<td>Cabang</td>
<td></td>
<td>Jl. Semeru No. 25 B, Kediri</td>
<td></td>
<td>Dewi Setyarini, S.Farm., Apt</td>
<td>P</td>
<td>19830401/SIKA_35.71/2012/2006</td>
<td></td>
<td>Sinyo M. Kolinug</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>693</td>
<td>P-0412</td>
<td>Cabang</td>
<td></td>
<td>Jl. K.H. Wakhid Hasyim No. 63, Kediri</t
d>
<td></td>
<td>Iwan Gustyawan, S.Farm., Apt.</td>
<td>L</td>
<td>19870904/STRA-UMS/2010/15514</td>
<td></td>
<td>Eddy Wijaya, SE</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>694</td>
<td>P-0453</td>
<td>Cabang</td>
<td></td>
<td>Jl. Dewi Sartika No. 8-10, Kediri</td>
<td></td>
<td>Aroma Ocfi Dwi Hapsari, S.Farm., Apt.</t
d>
<td>P</td>
<td>19841011/STRA-UAD/2009/210908</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>695</td>
<td>P-0587</td>
<td>Cabang</td>
<td></td>
<td></td>
<td>P</td>
<td>19880211/STRA-UNAIR/2011/23978</td>
<td></td>
<td>Arifudin</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>696</td>
<td>P-1038</td>
<td>Junger Farma, PT</td>

<td>Cabang</td>
<td></td>
<td>Jl. Raya Persada Sayang No. 2, Kediri</t
d>
<td></td>
<td>Winoto Adi Harsanto, S.Farm., Apt</td>
<td>P</td>
<td>19860826/STRA-UMS/2011/12339</td>
<td></td>
<td>Siswanto</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>697</td>
<td>P-1122</td>
<td>Mitra Farma Anugrah Lestari, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Slamet Riyadi No. 17, Kediri</td>
<td></td>
<td>Atika Kirana, S.Farm., Apt</td>
<td>P</td>
<td>19870920/STRA-UBAYA/2010/224469</td>
<td></td>
<td>Sri Tindarwati</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>698</td>
<td></td>
<td>Cabang</td>
<td></td>
<td>Jl. Manggar Manis No. 3, Madiun</td>
<td></td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>699</td>
<td></td>
<td>Andalas Putra Mandiri, PT</td>
<td>Cabang</td>
<td></td>
<td>Jl. Thamrin No. 61, Madiun</td>
<td></td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>700</td>
<td></td>
<td>Gunung Kencana Mulya, PT</td>
<td>Pusat</td>
<td></td>
<td>Perum Bumi Mas Blok J/13, Madiun</td>
<td></td>
<td>Susi Waijayanti</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>701</td>
<td></td>
<td>Wahyu Mitra Sejati, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Margahayu No. 3, Madiun</td>
<td></td>
<td>Lidia Sitepy</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>702</td>
<td></td>
<td>Tunggal Jaya Farma, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Diponegoro, Madiun</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>703</td>
<td>P-0098</td>
<td>Cabang</td>
<td></td>
<td>Jl. Yos Sudarso No. 29-31, Madiun</td>
<td></td>
<td>Ana Faridha, S.Farm., Apt</td>
<td>P</td>
<td>19870918/STRA-USB/2011/22400</td>
<td></td>
<td>Mahmudi</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>704</td>
<td>P-0533</td>
<td>Cabang</td>
<td></td>
<td>Jl. Tanjung Raya No. 42, Manisrejo, Madi
un</td>
<td></td>
<td>Safrida Nugrahenny, S.Farm., Apt</td>
<td>P</td>
<td>19850126/STRA-UBAYA/2009/222949</td>
<td></td>
<td>Henricus Setyo Jatmiko</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>705</td>
<td>P-0829</td>
>
<td>Cabang</td>
<td></td>
<td>Jl. Dr. Soetomo No. 33, Madiun</td>
<td></td>
<td>Ninin Wahyuni, S.Farm., Apt</td>
<td>P</td>
<td>503/870/401.103/SIKA.2/2012</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>706</td>
<td>P-1739</td>
<td>Lia Mitra Usaha, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Cokroaminoto No. 102, Madiun</td>
<td></td>
<td>Drs. Bambang Soemitro Abdoellah, Apt</td
>
<td>L</td>
<td>503/853/401.103/SIKA.6/2013</td>
<td></td>
<td>Yan Pradipta</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>707</td>
<td>P-1816</td>
<td>Sentrawaras Nusatama, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Bali No. 20, Madiun</td>
<td></td>
<td>Abdul Hamid Irsyad, S.Si., Apt.</td>

<td>L</td>
<td>19800416/STRA-UHAMKA/2010/17980</td>
<td></td>
<td>drg. Lisawati</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>708</td>
<td>P-1820</td>
td>
<td>Cabang</td>
<td></td>
<td>Jl. Setiabudi No. 10, Madiun</td>
<td></td>
<td>P</td>
<td>503/1972/401.103/AA.153/2010</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>709</td>
<td>P-1825</td>
<td>Elang Persada Medika, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Depok Manis No. 2, Manisrejo, Taman,
Madiun</td>
<td></td>
<td>Yayik Dwi Primadani, S.Farm., Apt</td>
<td>P</td>
<td>19870401/STRA-UMS/2011/226597</td>
<td></td>
<td>Bambang Kamahayanikan</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>710</td>
<td>P-1827</td>
<td>Lady Pharmindo, PT</td>

<td>Pusat</td>
<td></td>
<td>Jl. Sulawesi No. 16A, Madiun</td>
<td></td>
<td>Sri Yudho Endang P</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>711</td>
<td>P-1831</td>
<td>KPRI Husada Sejahtera, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Sumbawa No. 11, Madiun</td>
<td></td>
<td>Frensikatua Ariyanti</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>712</td>
<td></td>
<td>Hanjaya Perkasa Lestari Farma, PT</td>
<td>Cabang</td>
<td></td>
<td>Jl. Papandayan No. 10, Malang</td>
<td></td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>713</td>
<td></td>
<td>Hasma Jaya Agung, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Danau Singkarak No. E3, A12, Malang<
/td>
<td></td>
<td>Mundari</td>
<td>P</td>
<td>31786</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>714</td>
<td></td>
<td>Cabang</td>
<td></td>
>
<td></td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>715</td>
<td></td>
<td>Husena Pharmacy, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Jaksa Agung Suprapto No. 62, Malang<
/td>
<td></td>
<td></td>
<td></td>
<td>-</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>716</td>
<td></td>
<td>Cabang</td>
<td></td>
</td>
<td></td>
<td>Herlina Septika, S.Farm., Apt</td>
<td>P</td>
<td>19840717/STRA-UNAIR/2007/215343</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>717</td>
<td></td>
<td>Dasamitra Sembada Pharma, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Danau Toba C-37, Sawojajar, Malang</
td>
<td></td>
<td>Sri Pujiastuti, S.Farm., Apt</td>
<td>P</td>
<td>19871207/STRA-UAD/2012/226281</td>
<td></td>
<td>Dian Ika Prasetyawan</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>718</td>
<td></td>
<td>Gala Jaya Raya, PT</td>
<td>Cabang</td>
<td></td>
<td>Jl. Timah No. 10, Malang</td>
<td></td>
<td>Sukarti</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>719</td>
<td></td>
<td>Graha Kandhi Farma, PT</td>
<td>Cabang</td>
<td></td>
<td></td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>720</td>
<td></td>
<td>Great Mataram, PT</td>
<td>Cabang</td>
<td></td>
<td>Jl. Batanghari No. 3, Malang</td>
<td></td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>721</td>
<td></td>
<td>Parit Karya, PT</td>
<td>Pusat</td>
<td></td>
<td></td>
<td>Kustia M</td>
<td>P</td>
<td>446.AA/196/SIK/3573.306/2008</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>722</td>
<td></td>
<td>Pangestu Farmindo Muliatama, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Arjuna No. 34, Malang</td>
<td></td>
<td>Ninik Winarti.</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>723</td>
<td></td>
<td>Wigo, PT</td>
<td>Cabang</td>
<td></td>
<td>Jl. WR. Supratman No. 6, Malang</td>
<td></td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>724</td>
<td></td>
<td>Aloha Jaya, PT</td>
<td>Cabang</td>
<td></td>
<td>Jl. Suropati No. 40, Malang</td>
<td></td>
<td>L</td>
<td>446.AA/258/K/35.73.306/2009</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>725</td>
<td></td>
<td>Cabang</td>
<td></td>
<td>Jl. Topas No. 18, Tlogomas Lowok Waru, M
alang</td>
<td></td>
<td>Perawati, S.Farm., Apt</td>
<td>P</td>
<td>19850419/STRA-USB/2009/210086</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>726</td>
<td></td>
<td>Ultra Bintang Jaya Putra, PT</td>
<td>Cabang</td>
<td></td>
ang</td>
<td></td>
<td>Pusparini</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>727</td>
<td></td>
<td>Sadhana Mundi Sentosa, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Puter Utara No. 6-8, Malang</td>
<td></td>
<td>Anggi Putri Mandasari, S.Farm., Apt.</td
>
<td>P</td>
<td>19870424/STRA-UNAIR/2012/226685</td>
<td></td>
<td>Nunuk Rifayanti, SE., Ak.</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>728</td>
<td></td>
<td>Tadjur Putra Mandiri, PT</td>
<td>Cabang</td>
<td></td>
<td>Jl. Kesatrian Dalam No. 22, Malang</td>
<td></td>
<td>Kartini</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>729</td>
<td></td>
<td>Sandhana Mundi Sentosa, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Pelabuhan Tanjung Mas, Malang</td>
<td></td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>730</td>
<td></td>
<td>Benteng Gading Gemilang, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Titan VI/R.11, Malang</td>
<td></td>
<td>Nur Hidayati</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>731</td>
<td></td>
<td>Trisula Manunggal Jaya, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Letjen S.Parman No. 26, Malang</td>
<td></td>
<td>Maria Angela Andayani Susanto, S.Si., Ap
t.</td>
<td>P</td>
<td>19620513/STRA-UWM/1996/222532</td>
<td></td>
<td>Iwan Tessy</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>732</td>
<td></td>
<td>Dwi Putra Glory, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Blimbing Indah Tengah XVI Blok L1 No
. 24, Malang</td>
<td></td>
<td>Farid Zulkarnain Nur Syah</td>
<td>L</td>
<td>KP.01.03.13.4937</td>
<td></td>
<td>Jimmy Hertanto</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>733</td>
<td></td>
<td>Imanuel Mulia Farma, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Tenaga Baru II No. 5, Malang</td>
<td></td>
<td>Drs.Hadi, Apt</td>
<td>L</td>
<td>Kp.01.01.V.5.2.10371</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>734</td>
<td></td>
<td>Savero Farma, PT</td>
<td>Cabang</td>
<td></td>
<td>Jl. Raya Dieng No. 32, Malang</td>
<td></td>
<td></td>
<td></td>
<td>-</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>735</td>
<td></td>
<td>Sawah Besar Farma, PT</td>
<td>Cabang</td>
<td></td>
<td></td>

<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>736</td>
<td></td>
<td>Cabang</td>
<td></td>
<td>Jl. Terusan Batubara No. 30 C, Malang</t
d>
<td></td>
<td>Nela Oktaviani, S.Farm., Apt</td>
<td>P</td>
<td>19881011/STRA-UAD/2012/226237</td>
<td></td>
<td>Santoso</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>737</td>
<td></td>
<td>Usahatama Sentosa Mas, PT</td>
<td>Cabang</td>
<td></td>
<td>Jl. Halmahera No. 68 B, Malang</td>
<td></td>
<td>Astu Sri Wulanti, S.Farm., Apt.</td>
<td>P</td>
<td>51/SIKA/35.73.306/2013</td>
<td></td>
<td>Ineke Indrijani</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>738</td>
<td></td>
<td>Surya Prima Perkasa, PT</td>
<td>Cabang</td>
<td></td>
<td>Jl. Danau Toba , Ruko Sawojajar B2, Mala
ng</td>
<td></td>
<td>Vincent Amadeus Tutiz, S.Farm., Apt.</td
>
<td>L</td>
<td>60/SIKA/35.73.306/2013</td>
<td></td>
<td>Teguh Panca Widhiyanto</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>739</td>
<td></td>
<td>Unirama Duta Niaga, PT</td>
<td>Cabang</td>
<td></td>
<td>Jl. Sonokembang No. 12A, Malang</td>
<td></td>
<td>Masmariani, S.Si., Apt.</td>
<td>P</td>
<td>19681012/STRA-UWM/1994/24734</td>
<td></td>
<td>Suwarto</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>740</td>
<td></td>
<td>Surya Eka Putra, PT</td>
<td>Cabang</td>
<td></td>
<td>Pondok Blimbing Indah Utara Blok A6/19A,
RT/RW 11/05, Blimbing, Malang</td>
<td></td>
<td>Irfanto Hoesodo, S.Farm., Apt.</td>
<td>L</td>
<td>40/SIKA/35.73.306/2012</td>
<td></td>
<td>Yacobus Hendro Pranoto</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>741</td>
<td></td>
<td>Samudra Artha Pharmasino, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Pasir Putih No. 5, Malang</td>
<td></td>
<td>Marlina Septiana</td>
<td>P</td>
<td>0501.754.AA</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>742</td>
<td></td>
<td>Junger Farma Distribusi, PT</td>
<td>Cabang</td>
<td></td>
<td></td>
<td>Romdhoni, S.Farm., Apt</td>
<td>L</td>
<td>19860603/STRA-UMS/2011/12328</td>
<td></td>
<td>Arief Priohutomo, ST</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>743</td>
<td></td>
<td>Arta Boga Cemerlang, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Sunandar Priyosudarmo, Malang</td>
<td></td>
<td>Dra. Liana Gunawan,Apt</td>
<td>P</td>
<td>5016/B</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>744</td>
<td></td>
<td>Adi Buana Citra Dharmala, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Candi Panggung No. 1 G, Malang</td>
<td></td>
<td>The Artis Primalia, S.Farm., Apt.</td>
<td>P</td>
<td>011/SIKA/35.73.306/2012</td>
<td></td>
<td>Hari Kurnia</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>745</td>
<td></td>
<td>Waluyo Agung Sejati, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Kelud No. 12, Malang</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>746</td>
<td></td>
<td>Tunggal Sila Farma, PT</td>
<td>Cabang</td>
<td></td>
<td></td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>747</td>
<td></td>
<td>Karunia Prima Lestari, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Kertiraharjo No. 2 Kav. 2, RT/RW 04/
01, Kel. Ketawangede, Malang</td>
<td></td>
<td>Fariza Noor Laily, S.Farm., Apt.</td>
<td>P</td>
<td>57/SIKA/35.73.306/2013</td>
<td></td>
<td>Retna Wahyu Suryandari, SE.</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>748</td>
<td></td>
<td>Dwilandra Hida Utama, PT</td>
<td>Cabang</td>
<td></td>
<td></td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>749</td>
<td></td>
<td>Endojeris, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Andalas Tengah No. 23, Malang</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>750</td>
<td></td>
<td>Pramumitra Pharma, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Kaliurang Barat No. 113, Malang</td>
<td></td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>751</td>
<td>P-0033</td>
<td>Cabang</td>
<td></td>
<td>Jl. Delima No. 7, Malang</td>
<td></td>
<td>Dina Wifada, S.Farm., Apt</td>
<td>P</td>
<td>19850709/STRA-UNAIR/2011/214064</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>752</td>
<td>P-0035</td>
<td>Tempo, PT</td>
<td>Cabang</td>
<td></td>
<td>Jl. Raya Tlogo Mas No. 26-27, Malang</td

>
<td></td>
<td>Khoridah Septiningtyas, S.Farm., Apt</td
>
<td>P</td>
<td>19880913/STRA-UNAIR/2011/24046</td>
<td></td>
<td>Ai Ju, SE</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>753</td>
<td>P-0102</td>
<td>Cabang</td>
<td></td>
<td></td>
<td>Nurul Fitriyani, S.Farm., Apt</td>
<td>P</td>
<td>19830703/STRA-USB/2011/22486</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>754</td>
<td>P-0117</td>
<td>Cabang</td>
<td></td>
<td>Jl. Simpang Ranugrati No. 20, Malang</td
>
<td></td>
<td>Ricka Priscillia, S.Farm., Apt</td>
<td>P</td>
<td>19880710/STRA-UBAYA/2011/220550</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>755</td>
<td>P-0197</td>
<td>Cabang</td>
<td></td>
<td>Jl. Kyai Tamin No. 15/I-J, Malang</td>
<td></td>
<td>Enggar Mardaresta, S.Farm., Apt</td>
<td>P</td>
<td>19860307/STRA-USB/2009/215324</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>756</td>
<td>P-0220</td>
<td>Parit Padang Global, PT</td>
<td>Cabang</td>
<td></td>
<td>Jl. Tenaga Baru I No. 11 A, Malang</td>
<td></td>
<td>P</td>
<td>19871211/STRA-UWM/2011/26193</td>
<td></td>
<td>Jauw Herry</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>757</td>
<td>P-0292</td>
<td>Parazelsus Indonesia, PT</td>
<td>Cabang</td>
<td></td>
<td></td>
<td>Syahrial Fahrudin, S.Farm., Apt</td>
<td>L</td>
<td>19851029/STRA-UAD/2010/16479</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>758</td>
<td>P-0462</td>
<td>Distriversa Buanamas, PT</td>
<td>Cabang</td>
<td></td>
<td>Jl. Kunir No. 5, Malang</td>
<td></td>
<td>Dwi Prawita Widatama, S.Farm., Apt</td>
<td>P</td>
<td>18/SIKA/35.73.306/2012</td>
<td></td>
<td>Harijono</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>759</td>
<td>P-0465</td>
<td>Cabang</td>
<td></td>
<td></td>
<td>Indah Purnama Dewi, S.Farm., Apt</td>
<td>P</td>
<td>KP.01.03.1.3.1434</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>760</td>
<td>P-0472</td>
<td>Cabang</td>
<td></td>
<td></td>
<td>Yuni Mariyana ,S.Farm.Apt</td>
<td>P</td>
<td>17/SIKA/35.73.306/2012</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>761</td>
<td>P-0478</td>
<td>Cabang</td>
<td></td>
<td>Jl. A.Yani No. 138, Malang</td>
<td></td>
<td>Pungki Kusuma Jayanti, S.Farm., Apt</td>
<td>P</td>
<td>19841107/STRA-UNAIR/2011/24003</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>762</td>
<td>P-0502</td>
<td>Lab Medika Sejahtera, PT</td>
<td>Cabang</td>
<td></td>
<td>Jl. Kebalen No. 1B, Malang</td>
<td></td>
<td>P</td>
<td>-</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>763</td>
<td>P-0505</td>
<td>Cabang</td>
<td></td>
<td>Jl. Sunandar Priyo Sudarmo No. 26, Malan
g</td>
<td></td>
<td>Ratih Dewi Primahartutie, S.Farm., Apt</
td>
<td>P</td>
<td>15/SIKA/35.73.306/2012</td>
<td></td>
<td>Tavip Ismunandar</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>764</td>
<td>P-0506</td>
<td>Santa Abadi, PT</td>
<td>Pusat</td>
<td></td>
<td></td>
<td></td>
<td>Erlin Juni Triastutii</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>765</td>
<td>P-0512</td>
<td>Minaroza Farma, PT</td>
<td>Pusat</td>
<td></td>
<td></td>
<td>L</td>
<td>446.AA/237/SIK/3573.306/2009</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>766</td>
<td>P-0518</td>
<td>Cabang</td>
<td></td>
<td>Jl. Karya Barat No. 5, Malang</td>
<td></td>
<td>Angga Tan Satresna, S.Farm., Apt</td>
<td>L</td>
<td>12/SIKA/35.73.306/2012</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>767</td>
<td>P-0528</td>
>
<td>Cabang</td>
<td></td>
<td>Jl. A.Yani Utara No. 2, Malang</td>
<td></td>
<td>Sunarsih</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>768</td>
<td>P-0557</td>
<td>Zaifaza Farma, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Sukarno Hatta No. 7, Mojolangu, Mala
ng</td>
<td></td>
<td>Enny Wasaningsih Pramono</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>769</td>
<td>P-0560</td>
<td>Intan Baskara Mandiri, PT</td>
<td>Pusat</td>
<td></td>
<td></td>
<td>Novatum, S.Farm., Apt</td>
<td>P</td>
<td>19831106/STRA-USB/2012/225833</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>770</td>
<td>P-0607</td>
<td>Guntormisri Sentosa, PT</td>
<td>Pusat</td>
<td></td>
<td></td>
<td>Rosalia Megasari, S.Farm., Apt.</td>
<td>P</td>
<td>19880425/STRA-UAD/2012/228511</td>
<td></td>
<td>Misrina</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>771</td>
<td>P-0742</td>
td>
<td>Cabang</td>
<td></td>
<td>Jl. Hamid Rusdi No. 95, Kec. Blimbing, M
alang</td>
<td></td>
<td>Ayu Andini Ibrahim, S.Farm., Apt</td>
<td>P</td>
<td>19871219/STRA-UBAYA/2011/215661</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>772</td>
<td>P-0796</td>
<td>Cabang</td>
<td></td>
<td></td>
<td>Kartika Dewi Nastiti, S.Farm., Apt.</td>
<td>P</td>
<td>19890508/STRA-UAD/2012/228544</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>773</td>
<td>P-1169</td>
td>
<td>Cabang</td>
<td></td>
1/19, Malang</td>
<td></td>
<td>L</td>
<td>19860727/STRA-USB/2009/23506</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>774</td>
<td>P-1376</td>
<td>Cabang</td>
<td></td>
<td>Jl. Baluran No. 8, Malang</td>
<td></td>
<td>Nia Grahadian, S.Farm., Apt</td>
<td>P</td>
<td>19850718/STRA-UGM/2009/222546</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>775</td>
<td>P-1442</td>
<td>United Dico Citas, PT</td>
<td>Cabang</td>
<td></td>
<td>Jl. Nangka No. 11, Malang</td>
<td></td>
<td>Febrind Chandikya Nuria Majid, S.Farm, A
pt</td>
<td>P</td>
<td>19870204/STRA-UMS/2011/16334</td>
<td></td>
<td>Faisal, ST</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>776</td>
<td>P-1505</td>
<td>Cabang</td>
<td></td>
<td>Jl. Panji Suroso No. 20, Malang</td>
<td></td>
</td>
<td>P</td>
<td>18980723/STRA-UAD/2012/225747</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>777</td>
<td>P-1639</td>
<td>Cabang</td>
<td></td>
<td></td>
<td>Esti Chandra Rini, S.Farm, Apt</td>

<td>P</td>
<td>KP.01.03.1.3.3308</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>778</td>
<td>P-1650</td>
<td>Duta Dwisarana Prima, PT</td>
<td>Cabang</td>
<td></td>
<td></td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>779</td>
<td>P-1725</td>
<td>Mina Karya Usaha, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Sukarno Hatta No. 7, Malang</td>
<td></td>
<td>Furaida Arifani, S.Farm., Apt</td>
<td>P</td>
<td>19871207/STRA-UAD/2011/24108</td>
<td></td>
<td>Purwanto</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>780</td>
<td>P-1840</td>
<td>Cabang</td>
<td></td>
<td>Jl. Teluk Etna V/86, Malang</td>
<td></td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>781</td>
<td>P-2039</td>
<td>Hikmat Sejati Gemilang Farma, PT</td>
<td>Pusat</td>
<td></td>
<td></td>
<td>I.G.Santoso</td>
<td>L</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>782</td>
<td></td>
<td>Cabang</td>
<td></td>
<td>Jl. Anggrek No. 7, Probolinggo</td>
<td></td>
<td>Reta Djenis, S.Si., Apt.</td>
<td>P</td>
<td>19610210/STRA-UWM/1996/23793</td>
<td></td>
<td>Apeles Sugianto</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>783</td>
<td></td>
<td>PT.Alvindo Juhan Lestari, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Raya Kalirungkut No. 1-3 Blok L 11-1
2, Kompleks Ruko Megah Raya, Surabaya</td>
<td></td>
<td>Henny Whardani Indrajaya</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>784</td>
<td></td>
<td>Citra Husada Madani, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Manyar Indah VIII/12, Surabaya</td>
<td></td>
<td>E.L.Dwi Retno Wahyuni</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>785</td>
<td></td>
<td>Dalan Triputra Mandiri, PT</td>
<td>Pusat</td>
<td></td>
eks Ruko Megah Raya, Surabaya</td>
<td></td>
<td>Yunita Irwanto,Sfarm,Apt</td>
<td>P</td>
<td>KP.01.03.1.3.3380</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>786</td>
<td></td>
<td>Defina Rahmah, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Wisma Lidah Kulon Blok C-76, Surabay
a</td>
<td></td>
<td>Tri Udjiyanto</td>
<td>L</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>787</td>
<td></td>
<td>Procter & Gamble Home Products Indonesia
, PT</td>
<td>Cabang</td>
<td></td>
<td>Jl. Kalianak Barat Raya No. 66, Surabaya
</td>
<td></td>
<td>Luisa Pasadena,S.Farm,Apt</td>
<td>P</td>
<td>KP.01.03.1.3.1017</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>788</td>
<td></td>
<td>Aristama Andalan Mandiri, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Bhakti Husada III/1, Surabaya</td>
<td></td>
<td>Sudarmiyanti</td>
<td>P</td>
<td>111.6/13/SIAA</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>789</td>
<td></td>
<td>Prasetya Pratama Jaya Farma, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Darmo Kali No. 46, Surabaya</td>
<td></td>
<td>Afa Mardyani Hendra, S.Farm., Apt.</td>
<td>P</td>
<td>19860313/SIKA-35.78/2012/2026</td>
<td></td>
<td>Tjandra Kurnyawati Hendra</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>790</td>
<td></td>
<td>Permata Husada Utama, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Gayung Kebonsari No. 46, Perum Graha
Indah F-16, Surabaya</td>
<td></td>
<td>Matalia Deasy Rachmawati, S.Farm., Apt.<
/td>
<td>P</td>
<td>19791221/STRA-UWM/2007/222808</td>
<td></td>
<td>Maria Juliana Ch Malonda</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>791</td>
<td></td>
<td>Musafa Bhakti, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Jagiran No. 76, Surabaya</td>
<td></td>
<td>Drs. R.Sri Dono Poernomo</td>
<td>L</td>
<td>KP.01.03.1.3.5893</td>
<td></td>
<td>Retno Setyowati</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>792</td>
<td></td>
<td>Java Farma, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Tambak Segaran II/28, Surabaya</td>
<td></td>
<td>Yani Aristi Rini, S.Farm, Apt</td>
<td>P</td>
<td>KP.01.03.1.3.2446</td>
<td></td>
<td>Sri Andayani</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>793</td>
<td></td>
<td>Indo Medipharm, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Raya Mastrip Kedurus Dukuh No. 62, S
urabaya</td>
<td></td>
<td>Citra Kurniasari, S.Farm, Apt</td>
<td>P</td>
<td>KP.01.03.1.3.6196</td>
<td></td>
<td>Go Andreas Sugondo</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>794</td>
<td></td>
<td>Bintang Utama Inti, PT</td>

<td>Pusat</td>
<td></td>
<td>Ruko Sentra Tropodo C-25, Tropodo, Surab
aya</td>
<td></td>
Apt</td>
<td>P</td>
<td>KP.01.01.1.2.1186</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>795</td>
<td></td>
<td>Tri Stars Husada Lestari, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Kebon Rojo No. 6 AA, Surabaya</td>
<td></td>
<td>Evelyn Devi Melinda, S.Farm., Apt.</td>
<td>P</td>
<td>19890121/STRA-UBAYA/2012/229871</td>
<td></td>
<td>Lie Tan Lien</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>796</td>
<td></td>
<td>Sri Buana Sumber Lestari, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Kenjeran No. 561 A, Surabaya</td>
<td></td>
<td>Sari Angela Hendro Putri, S.Farm., Apt.<
/td>
<td>P</td>
<td>19890330/STRA-UBAYA/2011/218760</td>
<td></td>
<td>Oei (NG) Phik Gaih</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>797</td>
<td></td>
<td>Surya Medika Perkasa, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Karang Pilang Barat No. 200, Surabay
a</td>
<td></td>
<td>Lidia Megawati, S.Farm., Apt.</td>
<td>P</td>
<td>19870124/STRA-UNAIR/2010/28270</td>
<td></td>
<td>Henry Joewono</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>798</td>
<td></td>
<td>Surya Bioperkasa, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Tenggilis Tengah I/22, Surabaya</td>
<td></td>
<td>Silvia Kuncoro, S.Farm., Apt.</td>
<td>P</td>
<td>19800504/STRA-UBAYA/2004/218953</td>
<td></td>
<td>Rendy Motanto</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>799</td>
<td></td>
<td>Surya Adi Farma, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Rungkut Asri Utara X/33, Surabaya</t
d>
<td></td>
<td>Jenny Indratno, S.Si., Apt.</td>
<td>L</td>
<td>19760602/STRA-UWM/2002/218873</td>
<td></td>
<td>Surya Dinata Ali Harsanto</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>800</td>
<td></td>
<td>Selaras Kusuma, PT</td>
<td>Cabang</td>
<td></td>
<td>Jl. Manyar Kertoadi No. 95, Surabaya</td
>
<td></td>
<td>Rizky Perdana, S.Farm., Apt.</td>
<td>L</td>
<td>19880323/SIKA-35.78/2012/2054</td>
<td></td>
<td>Guwijanto</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>801</td>
<td></td>
<td>Sinar Rejo Farma, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Margomulyo Industri X/19, Blok EE Ka
v. 20, Surabaya</td>
<td></td>
<td>Yohanes Surya Permana, S.Farm., Apt.</td
>
<td>L</td>
<td>19871022/STRA-UWM/2011/11655</td>
<td></td>
<td>Gunawan T.</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>802</td>
<td></td>
<td>Sejahtera Surya Intrio, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Ngagel Jaya Utara No. 106, Surabaya<
/td>
<td></td>
<td>Cinthya Pisessa Gunawan, S.Farm., Apt.</
td>
<td>P</td>
<td>19880308/STRA-UWM/2011/26221</td>
<td></td>
<td>Alfrin Yunarso</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>803</td>
<td></td>
<td>Rapedian Nusantara, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Kalibokor No. 33, Surabaya</td>
<td></td>
<td>Rerie Oktaviani, S.Farm., Apt.</td>
<td>P</td>
<td>19891020/SIKA-35.78/2013/2162</td>
<td></td>
<td>M.J. Okky Tayu</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>804</td>
<td></td>
<td>Prima Farma Distribusi, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Arjuna No. 65, Surabaya</td>
<td></td>
<td>Novita Indah Purwati, S.Farm., Apt.</td>
<td>P</td>
<td>19821126/STRA-UWM/2007/214731</td>
<td></td>
<td>Thomas Lie</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>805</td>
<td></td>
<td>Nurrochmah Sinar Sejati, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Ngaglik III/16, Surabaya</td>
<td></td>
<td>Maharani Wahyuning Tyas, S.Farm., Apt.</
td>
<td>P</td>
<td>19861019/STRA-UNAIR/2010/29929</td>
<td></td>
<td>Moerijono</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>806</td>
<td></td>
<td>Mitra Sumber Abadi, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Raya Darmo Permai Selatan, Ruko Sent
ra Darmo Villa Blok B-15, Surabaya</td>
<td></td>
<td>Imelda, S.Farm., Apt.</td>
<td>P</td>
<td>19790524/STRA-UWM/2005/222464</td>
<td></td>
<td>Franky Aryanto Gunawan, ST.</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>807</td>
<td></td>
<td>Mitra Artha Perkasa, PT</td>
<td>Pusat</td>
<td></td>
<td>Galaxy Bumi Permai H4/2, Surabaya</td>
<td></td>
<td>Libra Pelangi, S.Farm., Apt.</td>
<td>P</td>
<td>19710930/SIKA-35.78/2013/2209</td>
<td></td>
<td>Tan Franky Tandayu</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>808</td>
<td></td>
<td>Lentera Indo Perkasa, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Jemur Andayani, Ruko Surya Inti Perm
ata Blok E 8-9, Surabaya</td>
<td></td>
<td>Fendry Handoko, S.Farm., Apt.</td>
<td>L</td>
<td>19840328/STRA-UWM/2008/10943</td>
<td></td>
<td>Sigit Setiyo Bawono</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>809</td>
<td></td>
<td>Lenko Surya Perkasa, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Diponegoro No. 162, Surabaya</td>
<td></td>
<td>Freddy Rusli, S.Farm., Apt.</td>
<td>L</td>
<td>19881208/SIKA-35.78/2013/1208</td>
<td></td>
<td>Jannes Kriseno</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>810</td>
<td></td>
<td>Pusat</td>
<td></td>
<td>Jl. Kencanasari Timur VIII/H-1, Surabaya
</td>
<td></td>
<td>Donnie Andreas, S.Farm., Apt.</td>
<td>L</td>
<td>19850416/SIKA-35.78/2013/1189</td>
<td></td>
<td>Drs. Paulus Totok Lusida, Apt.</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>811</td>
<td></td>
<td>Cabang</td>
<td></td>
<td>Jl. Biliton No. 14, Surabaya</td>
<td></td>
<td>Yuliana Hidayat, S.Farm., Apt.</td>
<td>P</td>
<td>19870719/STRA-UWM/2011/26222</td>
<td></td>
<td>Sugeng Santoso, SE.</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>812</td>
<td></td>
<td>Cabang</td>
<td></td>
<td>Jl. Kutisari Utara VII/18, Surabaya</td>
<td></td>
<td>Khoirun Nisa, S.Farm., Apt.</td>
<td>P</td>
<td>19880818/STRA-UAD/2011/24157</td>
<td></td>
<td>Suyanto</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>813</td>
<td></td>
<td>Hari Sehat, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Genteng Kali No. 67, Surabaya</td>
<td></td>
<td>Chynthia Dewi Sutanto, S.Si., Apt.</td>
<td>P</td>
<td>19781025/STRA-UBAYA/2002/29855</td>
<td></td>
<td>Irwan Ongko Widjojo, Ong</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>814</td>
<td></td>
<td>Gunung Mas Jaya Sentosa, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Manyar Kertoarjo IV/57, Surabaya</td
>
<td></td>
<td>Cristin Suko Purwati, S.Farm., Apt.</td>
<td>P</td>
<td>19850224/STRA-UNAIR/2011/220517</td>
<td></td>
<td>Wendy Christiansen</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>815</td>
<td></td>
<td>Global Farmindo Utama, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Petemon II/58, Surabaya</td>
<td></td>
<td>Mayliani Kurniawati, S.Farm., Apt.</td>
<td>P</td>
<td>19840510/STRA-UWM/2008/23952</td>
<td></td>
<td>Lusia Imelda, S.Si., Apt.</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>816</td>
<td></td>
<td>Galoeh Husada Farma, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Sulung Sekolagan No. 2 D-E, Surabaya

</td>
<td></td>
<td>Ika Riskayanti, S.Farm., Apt.</td>
<td>P</td>
<td>19870408/STRA-UNAIR/2011/24005</td>
<td></td>
<td>Harjono Sutanto</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>817</td>
<td></td>
<td>Farma Niaga Distribusindo, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Simopomahan No. 39-P, Surabaya</td>
<td></td>
<td>Aily Soegianto, S.Farm., Apt.</td>
<td>P</td>
<td>19791021/STRA-UBAYA/2002/230575</td>
<td></td>
<td>Sugianto Effendy</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>818</td>
<td></td>
<td>Era Milenia Bina Harapan, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Rungkut Madya Surabaya, Komplek Ruko
Grand City A-14</td>
<td></td>
<td>Christoper Wangsadjaja, S.Farm., Apt.</t
d>
<td>L</td>
<td>19811129/STRA-UBAYA/2004/16804</td>
<td></td>
<td>Lanny Kristanti</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>819</td>
<td></td>
<td>Enggang Mulia Nusa, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Rungkut Madya No. 163, Surabaya</td>
<td></td>
<td>Titiek Ruswatiningsih</td>
<td>P</td>
<td>111.613/SIAA/331/01679/VII/08</td>
<td></td>
<td>Herri</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>820</td>
<td></td>
<td>Barito Budi Pharmindo, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Jemursari Selatan VII/20-22, Surabay
a</td>
<td></td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>821</td>
<td></td>
<td>Cempaka Indah Murni, PT</td>
<td>Cabang</td>
<td></td>
<td>Jl. Gayungan PPN No. 7, Surabaya</td>
<td></td>
<td>Linda Kusumawati, S.Farm., Apt</td>
<td>P</td>
<td>19890610/STRA-UBAYA/2012/227121</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>822</td>
<td></td>
<td>Asri Pandunusa, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Manyar Jaya VIII/C-125, Surabaya</td
>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>823</td>
<td></td>
<td>Bekasurya Perdana, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Penjaringan Sari II B/11, Surabaya</
td>
<td></td>
<td>Srikusrini</td>
<td>P</td>
<td>31531/Pend/AAA</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>824</td>
<td></td>
<td>Belindo Farma, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Raya Darmo No. 143, Surabaya</td>
<td></td>
<td>Prasetya Budiawan</td>
<td>L</td>
<td>3811/B</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>825</td>
<td></td>
<td>Aditya Farmatama, PT</td>
<td>Cabang</td>
<td></td>
/td>
<td></td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>826</td>
<td></td>
<td>Bayaco Agung, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Margomulyo Industri IV Blok G No. 14
-16, Surabaya</td>
<td></td>
<td>Puspita Sariani</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>827</td>
<td></td>
<td>Bina Artha Lestari Utama, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Wiguna Timur XIII/1, Surabaya</td>
<td></td>
<td>Yulistyorini Dwi U</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>828</td>
<td></td>
<td>Anugrah Hasil Bersaudara, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Griya Kebraon Selatan 2B/24, Surabay
a</td>
<td></td>
<td>Erna M</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>829</td>
<td></td>
<td>Dian Citra Harapan, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Pucang Anom Timur IV/12, Surabaya</t
d>
<td></td>
<td>Adi Agung Putra</td>
<td>L</td>
<td>503.446/0005/SIK.AA/436.4.8/IV/2004</td>
<td></td>
<td>Drs. Purwo Adi Sarwono, SE, AK</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>830</td>
<td></td>
<td>Dian Adytama Sentosa, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Jetis Kulon I/1, Surabaya</td>
<td></td>
<td>I Nengah Astikaa</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>831</td>
<td></td>
<td>Aryaguna Cipta Sejahtera, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Rungkut Kidul IV Blok I No.8, Suraba
ya</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>832</td>
<td></td>
<td>Cendo Pratama Farma, PT</td>
<td>Pusat</td>
<td></td>
, Surabaya</td>
<td></td>
<td>Soendayati</td>
<td>P</td>
<td>5516/B</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>833</td>
<td></td>
<td>Aneka Usaha Karya Kita Koperasi, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Rungkut Industri Raya No. 6, Surabay
a</td>
<td></td>
<td>Harsono Irawan</td>
<td>L</td>
<td>6248/B</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>834</td>
<td></td>
<td>Bima Perkasa Ikerima, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Barata Jaya XVIII/2, Surabaya</td>
<td></td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>835</td>
<td></td>
<td>Pusat</td>
<td></td>
<td>Ruko Plaza Segi Delapan,Jl. Raya Darmo
Permai III Blok A-871, Surabaya</td>
<td></td>
<td>Roosyka Wahjuny, S.Si., Apt</td>
<td>P</td>
<td>19710608/STRA-UWM/2001/221144</td>
<td></td>
<td>Jongky Soerjono Noer Wonohardjo</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>836</td>
<td></td>
<td>Anugerah Abi Farma, PT</td>
<td>Pusat</td>
<td></td>
<td>Ruko Klampis Square Blok B-3, Surabaya</
td>
<td></td>
t</td>
<td>P</td>
<td>19440719/STRA-UBAYA/1992/218796</td>
<td></td>
<td>Purnama Sejati</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>837</td>
<td></td>
<td>Pierosca Terang Sukses Abadi, PT</td>
<td>Pusat</td>
<td></td>
td>
<td></td>
<td>Lenny Nurcahyani, S.Farm., Apt</td>
<td>P</td>
<td>19890214/STRA-UBAYA/2012/227116</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>838</td>
<td></td>
<td>Detta Winasha, PT</td>
<td>Pusat</td>
<td></td>
<td>Kompleks Pergudangan Meiko Abadi Blok A-
23, Surabaya</td>
<td></td>
<td>Liah Diah Oktora, S.Si., Apt</td>
<td>P</td>
<td>19741030/STRA-UGM/2000/218473</td>
<td></td>
<td>Winarno</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>839</td>
<td></td>
<td>Sehat Dapat Rejeki, PT</td>
<td>Pusat</td>
<td></td>
<td></td>
<td>Dra. Lanywati Soedarmadji, Apt</td>
<td>P</td>
<td>19660414/STRA-UBAYA/1994/221079</td>
<td></td>
<td>Suwanto Karyono</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>840</td>
<td></td>
<td>Jehovah Rafa, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Baratajaya XX/15 U, Surabaya</td>
<td></td>
<td>Abdul Kadir Jaelani, S.Farm., Apt</td>
<td>L</td>
<td>19740915/STRA-UBAYA/2000/10112</td>
<td></td>
<td>Dr. Fransiscus Nanga Roka</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>841</td>
<td></td>
<td>Rio Farma, PT</td>

<td>Pusat</td>
<td></td>
<td>Jl. Manukan Krajan 34, Blok 31 L/6, Sura
baya</td>
<td></td>
<td>Veliana, S.Farm., Apt</td>
<td>P</td>
<td>19771016/STRA-UWM/2003/214741</td>
<td></td>
<td>Herlin Romaningsih</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>842</td>
<td></td>
<td>Indomedika Anugerah Nusantara, PT</td>
<td>Pusat</td>
<td></td>
<td>Westwood Villa Blok AI No. 17, Pakuwon C
ity, Surabaya</td>
<td></td>
<td>Safithri Arijadi</td>
<td>P</td>
<td>111.6/13/SIAA/331/00567/III/08</td>
<td></td>
<td>Marcus Ani</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>843</td>
<td></td>
>
<td>Cabang</td>
<td></td>
<td>Jl. Rajawali No. 54, Surabaya</td>
<td></td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>844</td>
<td></td>
<td>Zorela Raya, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Branjangan No. 5-7, Surabaya</td>
<td></td>
<td>Victoria, S.Si., Apt.</td>
<td>P</td>
<td>19781022/STRA-UBAYA/2003/218786</td>
<td></td>
<td>Lindawati Rangga</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>845</td>
<td></td>
<td>Ednu Surya, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Nginden Intan Raya No. 29, Surabaya<
/td>
<td></td>
<td>Amanda Nur Aini, S.Farm., Apt.</td>
<td>P</td>
<td>19860421/STRA-UBAYA/2011/216952</td>
<td></td>
<td>Edward</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>846</td>
<td></td>
<td>Benzena, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Gembong Tebasan No. 14, Surabaya</td
>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>847</td>
<td></td>
<td>Beta Pharmindo Sempurna, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Sriwijaya No. 46, Surabaya</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>848</td>
<td></td>
<td>Bhakti Guna Sarana, PT</td>
<td>Cabang</td>
<td></td>
<td></td>
<td>L</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>849</td>
<td></td>
<td>Bhakti Husada KPRI, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Dukuh Setro XI/2, Surabaya</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>850</td>
<td></td>
<td>Bimala Sanjaya Megah, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Rungkut Mapan Tengah VIII/DG 16, Sur
abaya</td>
<td></td>
<td>Marietta Angelina Dian Soeheningsih</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>851</td>
<td></td>
<td>Cendikia Multi Pratama, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Pucang Anom Timur No. 34, Surabaya</
td>
<td></td>
<td>Ninik Setyawati</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>852</td>
<td></td>
<td>Bintang Central Sakti, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Kebonsari Baru No. 14, Surabaya</td>
<td></td>
<td>Sabarahwati</td>
<td>P</td>
<td>SIK No.503.446/0377/36776/SIKAA/436.5.5/
VI/2009</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>853</td>
<td></td>
<td>Borimex, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Jagir Wonokromo No. 100, Kompleks Ma
ngga Dua Blok A10 No. 1, Surabaya</td>
<td></td>
<td>Susy Handayani</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>854</td>
<td></td>
<td>Bukit Arta Guna, PT</td>
<td>Pusat</td>
<td></td>
<td>Kompleks Pertokoan Villa Bukit Mas Blok
RM-19,Jl. H. Abdul Wahab Siamin, Surabaya</td>
<td></td>
<td>Endah S Murdiyanti</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>855</td>
<td></td>
<td>Cahaya Anugerah, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Bintoro No. 11, Surabaya</td>
<td></td>
<td>P</td>
<td>4885/B</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>856</td>
<td></td>
<td>Catur Mandiri Farma, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Jemursari II/66, Surabaya</td>
<td></td>
<td>Endang Soebagjati</td>
<td>P</td>
<td>4885/B</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>857</td>
<td></td>
<td>Cabang</td>
<td></td>
<td>Jl. Bibis No. 14, Surabaya</td>
<td></td>
<td>Anita Tjahyono, S.Farm., Apt.</td>
<td>P</td>
<td>19840527/SIKA-35.78/2012/2118</td>
<td></td>
<td>Feby Feryansyah</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>858</td>
<td></td>
<td>Anugrah Wirasatama, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Barata Jaya XVII/37, Surabaya</td>
<td></td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>859</td>
<td></td>
<td>Astakarya Cipta Mandiri, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Barata Jaya XVIII/37</td>
<td></td>
<td>Nany Harmijanti</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>860</td>
<td></td>
<td>Bakti Prima Sehati, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Semolowaru No. 112, Surabaya</td>
<td></td>
<td>Erni Gunawan, S.Si., Apt.</td>
<td>P</td>
<td>19740806/SIKA-35.78/2013/2192</td>
<td></td>
<td>Sudirmanto</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>861</td>
<td></td>
<td>Alodia Diva Nusantara, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Rungkut Mejoyo Utara VII/A-5, Suraba
ya</td>
<td></td>
<td>Alif Fidias</td>
<td>L</td>
<td>21397</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>862</td>
<td></td>
<td>Acacia Jaya Abadi, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Raya Kalirungkut No. 3 Blok N 38-39,
Surabaya</td>
<td></td>
<td>Lim Agnes, S.Si., Apt.</td>
<td>P</td>
<td>19750517/STRA-UBAYA/2000/230350</td>
<td></td>
<td>Hartono Goenawan Limanto</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>863</td>
<td></td>
<td>Al Kahfi, PT</td>
<td>Cabang</td>
<td></td>
<td>Jl. Ploso Baru No. 190, Surabaya</td>
<td></td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>864</td>
<td>P-0023</td>
<td>Rajawali Nusindo Cabang Surabaya 1, PT</
td>
<td>Cabang</td>
<td></td>
<td>Jl. Kalimas Barat No. 35-37, Surabaya</t
d>
<td></td>
<td>Riza Ariesta Hellinda, S.Farm, Apt</td>
<td>P</td>
<td>19860413/SIKA-35.78/2012/2079</td>
<td></td>
<td>Drs. Bones Sembiring</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>865</td>
<td>P-0024</td>
<td>Bhakti Persada Saudara Pharma, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Pucang Sewu No. 17, Surabaya</td>
<td></td>
<td>Stephanie, S.Farm., Apt.</td>
<td>P</td>
<td>19880628/STRA-UBAYA/2011/222449</td>
<td></td>
<td>Dra. Paulin Linggadewi, Apt.</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>866</td>
<td>P-0027</td>
td>
<td>Cabang</td>
<td></td>
<td>Jl. Raya Tenggilis No. 101, Surabaya</td
>
<td></td>
<td>Agustina Eka Puspitasari, S.Farm, Apt</t
d>
<td>P</td>
<td>19840811/SIKA-35.78/2012/2049</td>
<td></td>
<td>Soepomo, SE</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>867</td>
<td>P-0031</td>
<td>Tri Tunggal Farmindo, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Medokan Asri Utara IX/39, Surabaya</
td>
<td></td>
<td>Maria Jessie Suprapto,S.Si,Apt</td>
<td>P</td>
<td>KP.01.01.1.3.13601</td>
<td></td>
<td>Johanes Sulistiono</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>868</td>
<td>P-0037</td>
<td>Pusat</td>
<td></td>
<td>Jl. Semut Baru Pengampon Square D-9, Sur
abaya</td>
<td></td>
<td>Sri Handayani, S.Farm, Apt</td>
<td>P</td>
<td>KP.01.03.1.3.0655</td>
<td></td>
<td>Markus</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>869</td>
<td>P-0039</td>
<td>Usaha Semesta Globalindo, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Ngagel Jaya Utara No. 2, Surabaya</t
d>
<td></td>
<td>Widha Sulistya Wulan, S.Farm., Apt.</td>
<td>P</td>
<td>KP.01.03.1.3.3714</td>
<td></td>
<td>Audia Erlangga</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>870</td>
<td>P-0040</td>
<td>Kartika Global Medika, PT</td>
<td>Pusat</td>
<td></td>
<td></td>
<td>Ie Aries Kriestianto,Sfarm.Apt</td>
<td>P</td>
<td>KP.01.03.1.3.7936</td>
<td></td>
<td>Drs.Tiantoro Wangsadjaja</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>871</td>
<td>P-0043</td>
<td>Daya Anugrah Dewasakti, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Taman Jemursari Selatan I/7, Surabay
a</td>
<td></td>
<td>Galih Wahyu Prasetyo, S.Farm., Apt</td>
<td>L</td>
<td>19850325/STRA-UP/2010/14828</td>
<td></td>
<td>Moch. Noerhadi Soeyani, SH</td>

<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>872</td>
<td>P-0053</td>
<td>Prana Keluarga Nusantara, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Rungkut Lor RL 2 D/2, Surabaya</td>
<td></td>
<td>Aulia Ariestya Dewi,S. Farm.Apt</td>
<td>P</td>
<td>19860413/STRA-UBAYA/2009/221128</td>
<td></td>
<td>Indramurti</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>873</td>
<td>P-0093</td>
<td>Cabang</td>
<td></td>
<td>Jl. Dukuh Pakis No. 11, Surabaya</td>
<td></td>
<td>Nining Hari Murti Wijaya, S.Farm., Apt</
td>
<td>P</td>
<td>19800920/STRA-UII/2005/220657</td>
<td></td>
<td>Motoh Elfian Nolly</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>874</td>
<td>P-0099</td>
<td>Cabang</td>
<td></td>
<td></td>
<td>Veronica Krisnawan, S.Farm., Apt</td>

<td>P</td>
<td>KP.00.03.1.3.2093</td>
<td></td>
<td>Leni</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>875</td>
<td>P-0100</td>
<td>Gemini Mandira Lestari, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Medokan Ayu MA II/O No. 9, Surabaya<
/td>
<td></td>
<td>Veronica Soejanto S.Farm., Apt</td>
<td>P</td>
<td>19830823/STRA-UWM/2008/219091</td>
<td></td>
<td>George A. Tanara</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>876</td>
<td>P-0101</td>
<td>Anugrah Argon Medica Cabang Surabaya 2,
PT</td>
<td>Cabang</td>
<td></td>
<td></td>
<td>Yoel Prawiro Christdian, S.Farm., Apt.</
td>
<td>L</td>
<td>19870106/SIKA-35.78/2012/2086</td>
<td></td>
<td>Untung Agusman</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>877</td>
<td>P-0111</td>
<td>Gelora Fajar Farma, PT</td>
<td>Cabang</td>
<td></td>
td>
<td></td>
<td>Elok Tri Handayani, S.Farm., Apt.</td>
<td>P</td>
<td>19881021/SIKA-35.78/2013/2188</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>878</td>
<td>P-0119</td>
PT</td>
<td>Cabang</td>
<td></td>
<td>Jl. Klampis Jaya No. 31 Blok J-K-L, Sura
baya</td>
<td></td>
<td>Meilia Puspita Sari., S.Farm., Apt</td>
<td>P</td>
<td>19850507/STRA-UWM/2011/26219</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>879</td>
<td>P-0149</td>
<td>Tempo Cabang Surabaya 1, PT</td>
<td>Cabang</td>
<td></td>
a</td>
<td></td>
<td>Suryani Widya Oktavia, S.Farm., Apt</td>
<td>P</td>
<td>1989001/STRA-UWM/2011/26237</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>880</td>
<td>P-0154</td>
<td>Irma Mitra Farma, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Baratajaya 19 No. 48 A, Surabaya</td
>
<td></td>
<td>Henny Mardiana, S.Farm., Apt</td>
<td>P</td>
<td>19820525/STRA-UNAIR/2011/24002</td>
<td></td>
<td>Djoenaidi Ingasto</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>881</td>
<td>P-0174</td>
<td>Inti Mulia Farma, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Pucang Jajar No. 45, Surabaya</td>
<td></td>
<td>Andini Puspitasari, S.Farm., Apt.</td>
<td>P</td>
<td>19900104/SIKA-35.78/2013/2226</td>
<td></td>
<td>Jimmy Agustiawan Liono</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>882</td>
<td>P-0182</td>
<td>Podo Mekar Jaya Sentosa, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Kalisari III/17B, 15 G, D, E, F, I,
J dan 42-44, Surabaya</td>
<td></td>
<td>Ria Virdia Nita, S.Farm., Apt</td>
<td>P</td>
<td>19880908/STRA-UBAYA/2011/215704</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>883</td>
<td>P-0207</td>
<td>Prima Mulia Sejahtera, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Taman Panjang Jiwo Permai No. 22, Su
rabaya</td>
<td></td>
<td>Nadya Rahma Wardhany, S.Farm, Apt</td>
<td>P</td>
<td>KP.01.03.1.3.1304</td>
<td></td>
<td>Tanuwidyana Lilananta</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>884</td>
<td>P-0221</td>
<td>Global Persada Farma, PT</td>
<td>Cabang</td>
<td></td>
<td></td>
<td>P</td>
<td>19870627/STRA-UWM/2010/212801</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>885</td>
<td>P-0227</td>
<td>Bina Sarana Husada Medika, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Ubi VII/3, Surabaya</td>
<td></td>
<td>Anggraeni Dwi Saputra, S.Farm., Apt.</td
>
<td>P</td>
<td>19890519/SIKA-35.78/2013/2185</td>
<td></td>
<td>Defniyetri</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>886</td>
<td>P-0241</td>
<td>Cabang</td>
<td></td>
<td>Jl. Gemblongan No. 73, Surabaya</td>
<td></td>
<td>Nurul Qomariyah, S.Farm., Apt</td>
<td>P</td>
<td>19831128/STRA-UNAIR/2007/27009</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>887</td>
<td>P-0254</td>
<td>Gunung Sarai, PT</td>
<td>Pusat</td>
<td></td>
<td></td>
<td>Nelchia Silvia, S.Farm., Apt</td>
<td>P</td>
<td>19801012/STRA-UBAYA/2005/225324</td>
<td></td>
<td>Sindu Rahardjo</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>888</td>
<td>P-0260</td>
<td>Parit Padang Global Cabang Surabaya 1, P

T</td>
<td>Cabang</td>
<td></td>
<td>Jl. Tumapel No. 10 A-12, Surabaya</td>
<td></td>
<td>Puspita Mayasari Sutanto, S.Farm., Apt</
td>
<td>P</td>
<td>19851117/STRA-UBAYA/2009/218770</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>889</td>
<td>P-0293</td>
<td>Antar Mitra Sembada Cabang Surabaya 2, P
T</td>
<td>Cabang</td>
<td></td>
<td>Jl. Putat Gede Indah No. 2-A, Surabaya</
td>
<td></td>
<td>Didit Pradipta, S.Farm., Apt</td>
<td>L</td>
<td>19880506/SIKA-35.78/2012/1015</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>890</td>
<td>P-0341</td>
<td>Cabang</td>
<td></td>
<td>Jl. Berbek Industri I No. 1 A, Surabaya<
/td>
<td></td>
<td>Kiki Kulia Aulia Haqque,S.Farm,Apt</td>
<td>P</td>
<td>19860629/SIKA_3515/2012/2055</td>
<td></td>
<td>Joshijanto Tanuhadi</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>891</td>
<td>P-0361</td>
T</td>
<td>Cabang</td>
<td></td>
<td></td>
<td>Vira Natalia Chendriawan, S.Farm, Apt</t
d>
<td>P</td>
<td>KP.01.03.1.3.3375</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>892</td>
<td>P-0393</td>
<td>Bina San Prima Cabang Surabaya 1, PT</td
>
<td>Cabang</td>
<td></td>
<td>Jl. Raya Gubeng No. 16, Surabaya</td>
<td></td>
<td>Noviane Tanzil, S.Farm., Apt</td>
<td>P</td>
<td>19881102/STRA-UWM/2012/227473</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>893</td>
<td>P-0484</td>
>
<td>Cabang</td>
<td></td>
d>
<td></td>
<td>Diayu Desmar Dika, S.Farm., Apt</td>
<td>P</td>
<td>19860704/STRA-UBAYA/2009/21189</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>894</td>
<td>P-0501</td>
<td>Cabang</td>
<td></td>
td>
<td></td>
<td>Aina Mujtahida Alwan,S.Farm.Apt</td>
<td>P</td>
<td>19861218/SIKA-35.78/2011/2003</td>
<td></td>
<td>Harijanto Tanuadisupena</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>895</td>
<td>P-0503</td>
<td>Cabang</td>
<td></td>
<td></td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>896</td>
<td>P-0509</td>
<td>Acacia Mitra Abadi, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Raya Panjang Jiwo Permai 1B 21, Ruko
Delta Permai Blok B-21, Surabaya</td>
<td></td>
<td>Sevi Diatutik, S.Si., Apt.</td>
<td>P</td>
<td>19770912/SIKA-35.78/2013/2198</td>
<td></td>
<td>Hartono Goenawan Limanto</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>897</td>
<td>P-0510</td>
<td>Bersaudara Sejahtera Utuh, PT</td>
<td>Pusat</td>
<td></td>
<td>Ruko Segi Delapan I No. A 871, Surabaya<
/td>
<td></td>
<td>Roosyka Wahyuny,Ssi,Apt</td>
<td>P</td>
<td>SP.KP.01.01.1.2.6482</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>898</td>
<td>P-0513</td>
<td>Cabang</td>
<td></td>
<td>Jl. Margorejo Indah No. 28, Surabaya</td
>
<td></td>
<td>Anita Puspasari, S.Farm., Apt.</td>
<td>P</td>
<td>19830128/SIKA-35.78/2013/2197</td>
<td></td>
<td>Arif Sofian Tedja</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>899</td>
<td>P-0514</td>
<td>Borwita Indah, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Kunir No. 9, Surabaya</td>
<td></td>
<td>Like Suhermien</td>
<td>P</td>
<td>5369/B</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>900</td>
<td>P-0515</td>
td>
<td>Cabang</td>
<td></td>
<td>Jl. Raya Jemursari No. 41, Surabaya</td>
<td></td>
<td>Ayek Dwi Rosiana, S.Farm., Apt</td>
<td>P</td>
<td>19880404/STRA-UNAIR/2011/24022</td>
<td></td>
<td>Drs. Lontung Sinaga, Apt.</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>901</td>
<td>P-0520</td>
<td>Anugrah Mitra Jaya, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Raya Panjang Jiwo No. 46-48, Ruko Pa
nji Makmur A-31, Surabaya</td>
<td></td>
<td>Liana Limdon, S.Si., Apt.</td>
<td>P</td>
<td>19770420/SIKA-35.78/2013/2210</td>
<td></td>
<td>Kristianto</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>902</td>
<td>P-0522</td>
td>
<td>Cabang</td>
<td></td>
<td>Jl. Kalibokor Selatan No. 152, Surabaya<
/td>
<td></td>
<td>Wulan Nawangsari, S.Farm., Apt</td>
<td>P</td>
<td>19800920/SIKA-35.78/2012/2027</td>
<td></td>
<td>Wijarnako</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>903</td>
<td>P-0525</td>
<td>Cabang</td>
<td></td>
<td>Jl. Darmokali No. 32, Surabaya</td>
<td></td>
<td>Sonya Trisnowati, S.Farm., Apt</td>
<td>P</td>
<td>19841114/SIKA-35.78/2012/2060</td>
<td></td>
<td>Sunardi</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>904</td>
<td>P-0526</td>
<td>Cabang</td>
<td></td>
<td>Jl. Margorejo Indah No. 8-12, Surabaya</
td>
<td></td>
<td>Afaf Abdul Karim,Sfarm,Apt</td>
<td>L</td>
<td>19861105/STRA-UBAYA/2009/221119</td>
<td></td>
<td>Ng. Hok Lung</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>905</td>
<td>P-0529</td>
<td>Amadea Devina Farma, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Rungkut Mejoyo Selatan IV/U-3, Surab
aya</td>
<td></td>
<td>Rangga Maniek Prabhananda, S.Farm., Apt.
</td>
<td>L</td>
<td>19851101/SIKA-35.78/2012/1156</td>
<td></td>
<td>Adhitya Maniek Prabhananda, S.Farm., Apt
.</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>906</td>
<td>P-0530</td>
<td>Cabang</td>
<td></td>
<td>Jl. Gubeng Pojok No. 25, Surabaya</td>
<td></td>
<td>Selvi Widya Astuti, S.Farm., Apt.</td>
<td>P</td>
<td>19870912/STRA-UWM/2011/29848</td>
<td></td>
<td>Januri Purwanto</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>907</td>
<td>P-0531</td>
<td>Gehael Nusantara, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Kencanasari Barat II/AA-7, Surabaya<
/td>
<td></td>
<td>Ana Puspowati, S.Si., Apt.</td>
<td>P</td>
<td>19780802/SIKA-35.78/2013/2214</td>
<td></td>
<td>Dra. Lily Sandra Wijaya</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>908</td>
<td>P-0538</td>
<td>Enseval Putera Megatrading Tbk Cabang Su
rabaya 2, PT</td>
<td>Cabang</td>
<td></td>
<td>Jl. Raya Kendangsari No. 45-47, Surabaya
</td>
<td></td>
<td>Yunita Irwanto, S.Farm., Apt</td>
<td>P</td>
<td>19830607/SIKA-35.78/2012/2010</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>909</td>
<td>P-0545</td>
<td>Blessindo Farma, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Mayjen Sungkono, Kompleks Wonokitri
<td></td>
<td>Yuliani Lemantara, S.Si., Apt.</td>
<td>P</td>
<td>19760310/SIKA-35.78/2013/2219</td>
<td></td>
<td>Noer Erniati Tampemawa</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>910</td>
<td>P-0625</td>
<td>Cabang</td>
<td></td>
Surabaya</td>
<td></td>
<td>Fitrieny Namelia, S.Farm., Apt</td>
<td>P</td>
<td>19830506/STRA-UGM/2008/214695</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>911</td>
<td>P-0635</td>
<td>Multi Dwi Abadi, PT</td>
<td>Pusat</td>
<td></td>
>
<td></td>
<td>Retno Kuswariningsih,S,Si,Apt</td>
<td>P</td>
<td>KP.01.01.1.2.1186</td>
<td></td>
<td>Edwin Surya</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>912</td>
<td>P-0674</td>
T</td>
<td>Cabang</td>
<td></td>
<td>Jl. Rungkut Industri I No. 19, Surabaya<
/td>
<td></td>
<td>Feronika Rasubala ,S.Farm,Apt</td>
<td>P</td>
<td>KP.01.03.1.3.1752</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>913</td>
<td>P-0718</td>
<td>Karunia Pharmindo Sejati, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Pacar Kembang II/109 B, Surabaya</td
>
<td></td>
<td>Wisen Yetial, S.Farm., Apt</td>
<td>L</td>
<td>19841228/STRA-UBAYA/2007/16482</td>
<td></td>
<td>Oentari Karyo Ndadari</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>914</td>
<td>P-0847</td>
<td>Gratia Jaya Farma, PT</td>
<td>Cabang</td>
<td></td>
<td></td>
<td>Anissa Irmania Utami, S.Farm., Apt.</td>
<td>P</td>
<td>19900712/SIKA-35.78/2013/2227</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>915</td>
<td>P-0944</td>

<td>Cabang</td>
<td></td>
</td>
<td></td>
<td>Wahid Bekti Fitrianto, S.Farm., Apt</td>
<td>L</td>
<td>19860626/STRA-UMS/2011/12327</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>916</td>
<td>P-1071</td>
<td>Pusat</td>
<td></td>
<td>Jl. Raya Kalirungkut 1-3 Blok N-12 Ruko,
Surabaya</td>
<td></td>
<td>Dyah Ayu Citrawati, S.Farm., Apt</td>
<td>P</td>
<td>19821120/STRA-UWM/2008/214736</td>
<td></td>
<td>Erni Wahyuningsih</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>917</td>
<td>P-1202</td>
<td>Cabang</td>
<td></td>
<td>Jl. Jagiran No. 76 Sby</td>
<td></td>
<td>Wulan Wiranti, S.Farm., Apt</td>
<td>P</td>
<td>KP.01.03.1.3.5893</td>
<td></td>
<td>Darmanto</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>918</td>
<td>P-1283</td>
<td>Cabang</td>
<td></td>
<td>Jl. Mojoklanggru Lor No. 227, Surabaya</
td>
<td></td>
<td>Ong Henny Kusumawaty, S.Farm., Apt.</td>
<td>P</td>
<td>19871124/STRA-UBAYA/2011/218822</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>919</td>
<td>P-1370</td>
<td>Prima Farmasindo Lestari, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Kenjeran No. 631, Surabaya</td>
<td></td>
<td>Verronisa Ermiani, S.Farm, Apt</td>
<td>P</td>
<td>19861204/STRA-UNAIR/2011/212819</td>
<td></td>
<td>Tjomo Tjengundoro</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>920</td>
<td>P-1465</td>
<td>Marga Nusantara Jaya Cabang Surabaya 1,
PT</td>
<td>Cabang</td>
<td></td>
<td>Jl. Jaksa Agung Suprapto No. 19, Surabay
a</td>
<td></td>
<td>Lisa Arianto, S.Farm., Apt</td>
<td>P</td>
<td>19870704/STRA-UWM/2010/214758</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>921</td>
<td>P-1484</td>
<td>Astro Mega Farma, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Kedalsari Selatan No. 16, Surabaya</
td>
<td></td>
<td>Agus Suprianto, S.Farm., Apt</td>
<td>L</td>
<td>19800829/STRA-UNAIR/2010/14951</td>
<td></td>
<td>Kliem Jo Ming</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>922</td>
<td>P-1514</td>
PT</td>
<td>Cabang</td>
<td></td>
>
<td></td>
<td>Yuliana, S.Farm., Apt</td>
<td>P</td>
<td>19881207/STRA-UBAYA/2011/222303</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>923</td>
<td>P-1567</td>
<td>Mitra Central Asia, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Raya Panjang Jiwo No. 46-48, Surabay
a</td>
<td></td>
<td>Dra. Julidawati Hartono, Apt</td>
<td>P</td>
<td>19650508/STRA-UBAYA/1994/218702</td>
<td></td>
<td>David Aryanto Goenawan</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>924</td>
<td>P-1653</td>
<td>Rezeki Husada Utama, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Manyar Indah No. 15, Surabaya</td>
<td></td>
<td>Dra. Emma Sundrawati Tanuwijaya, Ms, Apt
</td>
<td>P</td>
<td>19520801/STRA-UNAIR/1981/214659</td>
<td></td>
<td>Iswan</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>925</td>
<td>P-1655</td>
<td>Mulya Raya Petra Sejahtera, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Mulyosari Utara III/36-39A, Surabaya
</td>
<td></td>
<td>Diana Budiman, S.Farm, Apt</td>
<td>P</td>
<td>KP.00.03.1.3.3034</td>
<td></td>
<td>Simon Budhi Santoso R</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>926</td>
<td>P-1686</td>
<td>Datheo Pharma, PT</td>
<td>Pusat</td>
<td></td>
td>
<td></td>
<td>Marlia Ariyanti, S.Farm., Apt</td>
<td>P</td>
<td>19870311/STRA-UNAIR/2012/228765</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>927</td>
<td>P-1700</td>
<td>Surya Kasih, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Indrapura Baru No. 351 A, Lt. 2, Sur
abaya</td>
<td></td>
<td>Ambi Kuswita Rachmawati, S.Farm., Apt</t
d>
<td>P</td>
<td>19851210/STRA-UBAYA/2010/218779</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>928</td>
<td>P-1849</td>
<td>Effata Fajar Anugerah, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Rungkut Asri Barat I/25, RT/RW 01/12
</td>
<td></td>
<td>Leonardus Dico Djoewarno, S.Farm., Apt</
td>
<td>L</td>
<td>19891003/STRA-UBAYA/2012/17750</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>929</td>
<td>P-1851</td>
<td>Asita Sukses Abadi Pharmindo, PT</td>
<td>Pusat</td>
<td></td>
<td>Jl. Medokan Ayu MA 1-A No. 1, Surabaya</
td>
<td></td>
<td>Lenny Jayanti, S.Farm., Apt</td>
<td>P</td>
<td>19860719/STRA-UNAIR/2009/22399</td>
<td></td>
<td>Eria Trisniadi</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>930</td>
<td>P-2075</td>
<td>Cabang</td>
<td></td>
>
<td></td>
<td>Dra. Elisabeth Swandayani, Apt</td>
<td>P</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>931</td>
<td>P-2077</td>
PT</td>
<td>Cabang</td>
<td></td>
<td>Raya Manukan Wetan No. 14, RT/RW 01/01,
Manukan Wetan, Tandes, Surabaya</td>
<td></td>
<td>Ferdi Dwi Janarto, S.Farm., Apt</td>
<td>L</td>
<td>19880509/STRA-UNAIR/2011/10994</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>932</td>
<td>P-2089</td>
<td>Cabang</td>
<td></td>
a</td>
<td></td>
<td>Paul Octavianus, S.Farm., Apt.</td>
<td>L</td>
<td>19871015/STRA-UBAYA/2011/15347</td>
<td></td>
<td>Binsar Sitorus</td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>2013</td>
</tr>
<tr>
<td>933</td>
<td></td>
<td>Berkat Kurnia Farma, PT</td>
<td>Pusat</td>
<td>HK.07.01/V/087/14</td>
<td>Jl. Sedap Malam Blok K-12 Tamansari, Bon
dowoso</td>
<td>0332-422800</td>
<td>Vina Kristanto, S.Farm., Apt</td>
<td>P</td>
<td>19860511/STRA-UBAYA/2007/230093</td>
<td>PBF</td>
<td>Meri Tjhe Erfan</td>
<td></td>
<td>Aktif</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>934</td>
<td>P-1333</td>
<td>Cabang</td>
<td>-</td>
<td>-</td>
<td>P</td>
<td>PBF</td>
<td>-</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>935</td>
<td>P-0115</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Teuku Umar No.72, Jember</td>
<td>-</td>
<td>Ach. Riyadi, S.Farm., Apt.</td>
<td>L</td>
<td>19840706/STRA-USB/2010/16726</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>936</td>
<td>P-0460</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Letjen Sutoyo No.138, Kel Kranjingan
, Kec. Sumbersari, Jember</td>
<td>-</td>
<td>Dian Anggraini, S.Farm., Apt.</td>
<td>P</td>
<td>19850303/STRA-UII/2011/26258</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>937</td>
<td>P-0029</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Letjen Sutoyo No.138, RT/RW 02/03, K
ec. Kranjingan, Jember</td>
<td>-</td>
<td>Ika Nursiana, S.Farm., Apt.</td>
<td>P</td>
<td>19850505/SIKA_35.09/2012/2008</td>
<td>PBF</td>
<td>Suyanta</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>938</td>
<td></td>
<td>Cabang</td>
<td>-</td>
<td>-</td>
<td>P</td>
<td>-</td>
<td>PBF</td>
<td>-</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>939</td>
<td>P-0582</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Sentot Prawirodirjo No.42, Jember</t
d>
<td>-</td>
<td>Dyah Suci Nurani, S.Farm., Apt.</td>
<td>P</td>
<td>19870122/STRA-UNUD/2011/24808</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>940</td>
<td>P-0253</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Wolter Monginsidi No.889, Rowo Indah
Ajung, Jember</td>
<td>-</td>
<td>Fahmi Ulfi, S.Farm., Apt.</td>
<td>L</td>
<td>19870704/SIKA_35.09/2011/1003</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>941</td>
<td></td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Imam Bonjol No.37, Kaliwates, Jember
</td>
<td>-</td>
<td>Silfiana Nisa Permatasari, S.Farm., Apt.
</td>
<td>P</td>
<td>19890623/STRA-UWM/2012/230035</td>
<td>PBF</td>
<td>Muchamad Syukri</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>942</td>
<td>P-0744</td>
<td>Cabang</td>
<td>-</td>
<td>-</td>
<td>Maulidia Rahmani, S.Farm., Apt.</td>

<td>P</td>
<td>19881130/STRA-ITB/2011/26560</td>
<td>PBF</td>
<td>Roby Wibowo, S.Ikom.</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>943</td>
<td>P-1491</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Sentot Prawirodirjo No.30, Jember</t
d>
<td>-</td>
<td>Ike Nur Fitriana, S.Farm., Apt.</td>
<td>P</td>
<td>19890507/STRA-UNAIR/2011/24014</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>944</td>
<td>P-1130</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. KH. Shiddiq No.110, Jember Kidul, Ka
liwates, Jember</td>
<td>-</td>
<td>Ika Dewi Manesti, S.Farm., Apt.</td>
<td>P</td>
<td>19830317/STRA-UNAIR/2006/221346</td>
<td>PBF</td>
<td>Pamuji</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>945</td>
<td>P-0597</td>

<td>Cabang</td>
<td>-</td>
<td>Jl. Letjen Sutoyo No.87, Jember</td>
<td>-</td>
<td>Ade Zona Akhirita Junjungan, S.Farm., Ap
t.</td>
<td>L</td>
<td>19861226/SIKA_35.09/2012/2018</td>
<td>PBF</td>
<td>M. Daniel Dianugrah Mitak</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>946</td>
<td>P-0819</td>
td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Kertanegara No.210, Jember</td>
<td>-</td>
<td>Dewi Rahmawati, S.Farm., Apt.</td>
<td>P</td>
<td>19870408/STRA-UMS/2009/221348</td>
<td>PBF</td>
<td>Suwoto</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>947</td>
<td>P-0444</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Imam Bonjol No.6, Kaliwates, Jember<
/td>
<td>-</td>
<td>Febrian Wahyu Mushonnifa S,Farm, Apt.</t
d>
<td>L</td>
<td>19860212/SIKA_35.09/2012/2014</td>
<td>PBF</td>
<td>Arif Rahman Hakim</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>948</td>
<td></td>
>
<td>Cabang</td>
<td>-</td>
<td>Jl. PB Sudirman No.71, Jember</td>
<td>-</td>
<td>P</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>949</td>
<td>P-0495</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Arowana No.69, Jember</td>
<td>-</td>
<td>Mae'Atul Hasanah</td>
<td>P</td>
<td>440/016/436.317/2005</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>950</td>
<td>P-0496</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Tawang Mangu No.131 A, Jember</td>
<td>-</td>
<td>Rio Dedi Pranoto S.Farm., Apt.</td>
<td>L</td>
<td>19870114/STRA-UNUD/2011/11242</td>
<td>PBF</td>
<td>Satrio Budi Utomo</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>951</td>
<td></td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Hayam Wuruk No.191, Jember</td>
<td>-</td>
<td>P</td>
<td>440/018/436.317/2006</td>
<td>PBF</td>
<td>Samuel Iskandar </td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>952</td>
<td></td>
<td>Saa Sari Tama, PT</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Sumatera No.78, Jember</td>
<td>-</td>
<td>P</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>953</td>
<td>P-0198</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Mojopahit Blok Y No.8, Kaliwates, Je
mber</td>
<td>-</td>
<td>Widya Ari Sukmawati, S.Farm., Apt.</td>
<td>P</td>
<td>19850111/SIK-35.09/2011/2002</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>954</td>
<td>P-0500</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Teuku Umar No.87, Tegal Besar, Kaliw
ates, Jember</td>
<td>-</td>
<td>Ummul Mursidah, S.Farm., Apt.</td>
<td>P</td>
<td>19870905/SIKA_35.09/2011/2001</td>
<td>PBF</td>
<td>Sugiantoro</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>955</td>
<td>P-1390</td>
<td>Tempo, PT</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Teuku Umar No.87, Jember</td>
<td>-</td>
<td>Riang Pramulia, S.Farm., Apt.</td>
<td>P</td>
<td>19890818/SIKA_35.09/2015/2029</td>
<td>PBF</td>
<td>Mochammad Hasmi Azhari</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>956</td>
<td>P-0199</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Yos Sudarso No.48 B, Jombang</td>
<td>-</td>
<td>Victa Elshera Pradana, S.Farm., Apt.</td
>
<td>P</td>
<td>KP. 01.03.1.3.3245</td>
<td>PBF</td>
<td>Sutadji</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>957</td>
<td>P-1070</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Mayor Bismo No.229, Kediri</td>
<td>-</td>
<td>Eko Siswanto, S.Farm., Apt.</td>
<td>L</td>
<td>19870526/STRA-USB/2011/10572</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>958</td>
<td>P-0534</td>
<td>Tempo, PT</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Mataram No.176, Kediri</td>
<td>-</td>
<td>Dina Mariani.S.Farm., Apt.</td>
<td>P</td>
<td>19850320/STRA-UNAIR/2009/215309</td>
<td>PBF</td>
<td>Mochamad Sofyan</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>959</td>
<td>P-0476</td>
<td>Cabang</td>
<td>-</td>
<td>-</td>
<td>Ainul Rodiyah S.Si, Apt.</td>
<td>P</td>
<td>19761029/SIKA_35.19/2012/2004</td>
<td>PBF</td>
<td>Nanang Arvianto</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>960</td>
<td>P-1483</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Raya Solo No.154, Jiwan, Madiun</td>
<td>-</td>
<td>Sri Prihatiningsih, S.Farm., Apt.</td>
<td>P</td>
<td>19870312/STRA-USB/2011/22509</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>961</td>
<td></td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Raya Tiron No.64, Nglames, Madiun</t
d>
<td>-</td>
<td>Lanawati</td>
<td>P</td>
<td>-</td>
<td>PBF</td>
<td>-</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>962</td>
<td>P-0194</td>
<td>Cabang</td>
<td>-</td>
<td>-</td>
<td>Ruly Jayanti, S.Farm., Apt.</td>
<td>P</td>
<td>KP.01.03.1.3.3343</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>963</td>
<td></td>
<td>Pusat</td>
<td>HK.07.01/V/229/14</td>
<td>Jl. Soekarno-Hatta Ruko Taman Niaga Blok
B12/B15 Malang</td>
<td>0341-411768, 404770 / 404774</td>
<td>Gloria Taufani Ungu, S.Farm., Apt.</td>
<td>P</td>
<td>19831102/STRA-UNAIR/2012/225605</td>
<td>PBF</td>
<td>Hariyadi</td>
<td></td>
<td>Aktif</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>964</td>
<td>P-0392</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Industri No.90, RT/RW 03/01, Ds. Man
gliawan Pakis, Malang</td>
<td>-</td>
<td>Titi Irmawati, S.Farm., Apt.</td>
<td>P</td>
<td>19880503/STRA-UAD/2015/231027</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>965</td>
<td></td>
<td>Guntormisri Sentosa, PT</td>
<td>Pusat</td>
<td>HK.07.01/V/498/13</td>
<td>Jl. Tapak Liman No. 15 Malang</td>
<td>0341-404076</td>
<td>Murni Devina Pratiwi, S.Farm., Apt.</td>
<td>P</td>
<td>19891202/STRA-UAD/2014/236990</td>
<td>PBF</td>
<td>Misriana</td>
<td></td>
<td>Aktif</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>966</td>
<td></td>
<td>Hapeel Pharmindo, PT</td>
<td>Pusat</td>
<td>HK.07.01/V/195/14</td>
<td>Jl. Bukit Dieng B-1 Malang</td>
<td>0341-557555 / 557455</td>
<td>Anna Befi, S.Farm., Apt.</td>
<td>P</td>
<td>19890217/STRA-UNAIR/2013/233004</td>
<td>PBF</td>
<td>Liani Hidayat</td>
<td></td>
<td>Aktif</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>967</td>
<td></td>
<td>Imanuel Mulia Farma, PT</td>
<td>Pusat</td>
<td>HK.07.01/V/102/14</td>
<td>Jl. Tenaga Baru II No. 5 Malang</td>
<td>0341-416480, 2280133, 088803300872 / 416
479</td>
<td>Dewi Ari Sandi, S.Farm., Apt</td>

<td>P</td>
<td>19900904/STRA-UGM/2013/232618</td>
<td>PBF</td>
<td></td>
<td>Aktif</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>968</td>
<td></td>
<td>Intan Baskara Mandiri Farma, PT</td>
<td>Pusat</td>
<td>HK.07.01/V/468/12</td>
<td>0341-352288</td>
<td>Devi Rasa Wulan, S.Farm., Apt.</td>
<td>P</td>
<td>19890901/STRA-USB/2014/235761</td>
<td>PBF</td>
<td></td>
<td>Aktif</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>969</td>
<td></td>
<td>Mina Karya Usaha, PT</td>
<td>Pusat</td>
<td>HK.07.01/V/008/13</td>
<td>Jl. Soekarno Hatta No. 7 Malang</td>
<td>0341-497021</td>
<td>Dian Retno Palupi, S.Farm., Apt.</td>
<td>P</td>
<td>19910621/STRA-USD/2014/237016</td>
<td>PBF</td>
<td>Purwanto</td>
<td></td>
<td>Aktif</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>970</td>
<td></td>
<td>Nusa Sari Pharma, PT</td>
<td>Pusat</td>
<td>HK.07.01/V/534/12</td>
<td>Jl. Anusapati No. 59 Singosari Kab. Mala
ng - Jawa Timur</td>
<td>0341-453719 / 441911</td>
<td>Ahmad Fajar Nata Atmaja, S.Farm., Apt.</
td>
<td>L</td>
<td>19870630/STRA-USB/2013/18991</td>
<td>PBF</td>
<td>Sukarno</td>
<td></td>
<td>Aktif</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>971</td>
<td></td>
<td>Pangestu Farmindo Muliatama, PT</td>
<td>Pusat</td>
<td>HK.07.01/V/266/14</td>
<td>0341-560902</td>
<td>Levina Subandi, S.Farm., Apt.</td>
<td>P</td>
<td>19880327/STRA-UBAYA/2011/215649</td>
<td>PBF</td>
<td>Kuswandi</td>
<td></td>
<td>Aktif</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>972</td>
<td></td>
<td>Sejahtera Surya Intramedika, PT</td>
<td>Pusat</td>
<td>HK.07.01/V/253/14</td>
<td>Ruko Sukarno Hatta Indah Blok B-4 Malang
- Jawa Timur</td>
<td>-</td>
<td>Dwi Mey Vitasari, S.Far., Apt.</td>
<td>P</td>
<td>19810522/STRA-UAD/2006/223093</td>
<td>PBF</td>
<td>Ronny Subagio</td>
<td></td>
<td>Aktif</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>973</td>
<td></td>
<td>Suprausadhatama, PT</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Mondoroko No.169 A, Pagentan, Singos
ari, Malang</td>
<td>-</td>
<td>Revi Oktaviana, S.Farm., Apt.</td>
<td>P</td>
<td>19891011/STRA-ITB/2012/229235</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>974</td>
<td>P-0527</td>
<td>Tri Saa Jaya, PT</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Raya Karanglo No.73 A, RT/RW 03/04,
Banjararum, Singosari, Malang</td>
<td>-</td>
<td>Utami Puji Rahayu Fransisca, S.Farm., Ap
t.</td>
<td>P</td>
<td>19830802/SIKA_35.07/2015/2028</td>
<td>PBF</td>
<td>Andry Mulia Sirait</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>975</td>
<td></td>
<td>Seles Global Farma, PT</td>
<td>Pusat</td>
<td>HK.07.01/V/363/2014</td>
<td>Dusun Talun No. 1, Desa Gununggangsir Ke
c. Beji Kab. Pasuruan</td>
<td>0343-658693 / 658692</td>
<td>Yongky Rianto Gunadi, S.Farm., Apt.</td>
<td>L</td>
<td>19860614/STRA-UWM/2009/19373</td>
<td>PBF</td>
<td>Pek Sugiarto Pangestu</td>
<td></td>
<td>Aktif</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>976</td>
<td></td>
<td>Arvinda Jaya Abadi, PT</td>
<td>Pusat</td>
<td>HK.07.01/V/171/14</td>
<td>Jl. Raya Gedangan 214 A Blok A1 Pergudan
gan Gedangan Permai</td>
<td>031-8012000 / 8010881</td>
<td>Catharina Dian Novita Handadari, S.Farm.
, Apt.</td>
<td>P</td>
<td>19881126/STRA-UBAYA/2012/229861</td>
<td>PBF</td>
<td>Antonio Arend Winardi</td>
<td></td>
<td>Aktif</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>977</td>
<td></td>
<td>Bina Mitra Jaya Bersama, PT</td>
<td>Pusat</td>
<td>HK.07.01/V/188/14</td>
<td>Jl. Raya Waru, Ruko Gate Way A 34-37 Sid
oarjo </td>
<td>031-8548445</td>
<td>Ristiyanti, S.Si., Apt.</td>
<td>P</td>
<td>19750906/STRA-UNAIR/2002/224189</td>
<td>PBF</td>
<td>Felix Wiyono</td>
<td></td>
<td>Aktif</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>978</td>
<td></td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Raya Waru No.44, Waru, Sidoarjo</td>
<td>-</td>
<td>L</td>
<td>PBF</td>
<td>-</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>979</td>
<td></td>
<td>Citra Mandiri Farmatama, PT</td>
<td>Cabang</td>
<td>-</td>
<td>-</td>
<td>Djamilah</td>
<td>P</td>
<td>PBF</td>
<td>-</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>980</td>
<td></td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Nangka No.265, Desa Sruni Gedangan</
td>
<td>-</td>
<td>Welky Alfianto, S.Farm., Apt.</td>
<td>L</td>
<td>19890325/SIKA_3515/2015/1020</td>
<td>PBF</td>
<td>Sugeng Pribadi</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>981</td>
<td>P-0906</td>
<td>Dempo Sentosa, PT</td>

<td>Cabang</td>
<td>-</td>
, Sidoarjo</td>
<td>-</td>
<td>Hendrik, S.Farm., Apt.</td>
<td>L</td>
<td>19880618/STRA-UWM/2012/17867</td>
<td>PBF</td>
<td>Ronnijanto Tanuhadi</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>982</td>
<td>P-0536</td>
<td>Enseval Putra Megatrading Tbk Cabang Sur
abaya 1, PT</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Berbek Industri VII No.8-10, Sidoarj
o</td>
<td>-</td>
<td>Fatimatus Zahroh, S.Farm., Apt.</td>
<td>P</td>
<td>19840222/STRA-UBAYA/2007/218507</td>
<td>PBF</td>
<td>Henry Sudarto</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>983</td>
<td></td>
<td>Cabang</td>
<td>-</td>
<td>Jl. A.Yani No.41-43. Kompleks Pergudanga
n Central Square Blok E 5, Gedangan, Sidoarjo</td>
<td>-</td>
<td>P</td>
<td>PBF</td>
<td>-</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>984</td>
<td></td>
<td>Kairos Pharma, PT</td>
<td>Pusat</td>
<td>HK.07.01/V/320/14</td>
<td>Jl. Taruna IX B No. Kav. 183 Wage, Sidoa
rjo.</td>
<td>031-8549908</td>
<td>Petrus Mikhael Rusli Odja, S.Farm., Apt.
</td>
<td>L</td>
<td>19860126/STRA-USB/2012/18521</td>
<td>PBF</td>
<td>Luyse Meriana Nusa</td>
<td></td>
<td>Aktif</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>985</td>
<td>P-0516</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Palm 2 Blok TD No.23, Pondok Candra
<td>-</td>
<td>Silmi Diana, S.Farm., Apt.</td>
<td>P</td>
<td>19880705/SIKA_3515/2015/2002</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>986</td>
<td>P-1549</td>
td>
<td>Cabang</td>
<td>-</td>
<td>-</td>
<td>Rudi Syahrial, S.Farm., Apt.</td>
<td>L</td>
<td>19840422/STRA-UNAND/2008/10665</td>
<td>PBF</td>
<td>Drs. Budi Asmono, Apt.</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>987</td>
<td>P-0539</td>
<td>Cabang</td>
<td>-</td>
Nila Alam 10/12, Sidoarjo</td>
<td>-</td>
<td>I.Gusti Ayu Prasanthy Suweda,S.Farm, Apt
.</td>
<td>P</td>
<td>19851024/DTRA-UBAYA/2009/219060</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>988</td>
<td></td>
<td>Cabang</td>
<td>-</td>
<td>-</td>
<td>P</td>
<td>19871119/STRA-UMS/2011/28601</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>989</td>
<td>P-0166</td>

<td>Cabang</td>
<td>-</td>
/td>
<td>-</td>
<td>Reny Kusuma Wardani, S.Farm., Apt.</td>
<td>P</td>
<td>19890526/SIKA_3515/2015/2024</td>
<td>PBF</td>
<td>Sarwono</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>990</td>
<td></td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Raya Buncitan No.1A, Sedati Juanda,
Sidoarjo</td>
<td>-</td>
<td>P</td>
<td>PBF</td>
<td>-</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>991</td>
<td></td>
<td>Cabang</td>
<td>-</td>
No.10-12, Sidoarjo</td>
<td>-</td>
<td>P</td>
<td>PBF</td>
<td>-</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>992</td>
<td></td>
<td>Richtji, PT</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Nanas VII No.679, Pondok Candra, Sid
oarjo</td>
<td>-</td>
<td>P</td>
<td>0502.1733.AA</td>
<td>PBF</td>
<td>-</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>993</td>
<td>P-0660</td>
<td>San Prima Sejati, PT</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Rajawali No.31, Rewin, Waru, Sidoarj
o</td>
<td>-</td>
<td>Ayu Menik Ariyanti, S.Si., Apt.</td>
<td>P</td>
<td>19790619/STRA-UNAIR/2004/227367</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>994</td>
<td></td>
<td>Solaris Multi Abadi, PT</td>
<td>Pusat</td>
<td>HK.07.01/V/297/11</td>
<td>Komplek Pergudangan Westgate Diamond Blo
k B-9 RT. 001 Wedi, Gedangan - Sidoarjo</td>
<td>031-8910825</td>
<td>Muhammad Irfan Kristianto, S.Farm., Apt.
</td>
<td>L</td>
<td>19890630/STRA-UBAYA/2012/18607</td>
<td>PBF</td>
<td>Tutur</td>
<td></td>
<td>Aktif</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>995</td>
<td>P-0577</td>
<td>Tri Saa Jaya, PT</td>
<td>Cabang</td>
<td>-</td>
<td>Ruko Gateway Blok F No.10-12, Sidoarjo</
td>
<td>-</td>
<td>Nur Madusari,S.Farm, Apt.</td>
<td>P</td>
<td>19830218/SIKA_3515/2015/2025</td>
<td>PBF</td>
<td>Liem Wie Yong</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>996</td>
<td>KAB. TUBAN</td>
<td></td>
<td>Mitra Sejati Distribusi, PT</td>
<td>Pusat</td>
<td>HK.07.01/V/352/14</td>
<td>Jl. Manunggal 35 Tuban</td>
<td>0356-331555</td>
<td>Yuanita Handoko, S.Farm., Apt.</td>
<td>P</td>
<td>19811015/STRA-UBAYA/2006/234105</td>
<td>PBF</td>
<td>Aswin Sunaryo</td>
<td></td>
<td>Aktif</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>997</td>
<td>KOTA BATU</td>
<td></td>
<td>Mas Rose Citra Abadi, PT</td>
<td>Pusat</td>
<td>HK.07.01/V/492/13</td>
<td>Jl. Raya Gasiran Wetan No. 09 Junrejo -
Batu</td>
<td>0341-2998224</td>
<td>Agustina Sri Lestari, S.Si., Apt.</td>
<td>P</td>
<td>19770816/STRA-USB/2014/235743</td>
<td>PBF</td>
<td>Drs. M. Rosyidi, MM</td>
<td></td>
<td>Aktif</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>998</td>
<td>P-0412</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. K.H. Wakhid Hasyim No.63, Kediri</td
>
<td>-</td>
<td>Iwan Gustyawan, S.Farm., Apt.</td>
<td>L</td>
<td>19870904/STRA-UMS/2010/15514</td>
<td>PBF</td>
<td>Eddy Wijaya, SE</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>999</td>
<td>P-0410</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Semeru No.25 B, Kediri</td>
<td>-</td>
<td>Dewi Setyarini, S.Farm., Apt.</td>
<td>P</td>
<td>19830401/SIKA_35.71/2012/2006</td>
<td>PBF</td>
<td>Sinyo M. Kolinug</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1000</td>
<td>P-1038</td>
<td>Junger Farma, PT</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Raya Persada Sayang No.2, Kediri</td
>
<td>-</td>
<td>Winoto Adi Harsanto, S.Farm., Apt.</td>
<td>P</td>
<td>19860826/STRA-UMS/2011/12339</td>
<td>PBF</td>
<td>Siswanto</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1001</td>
<td></td>
<td>Cabang</td>
<td>-</td>
<td>-</td>
<td>Anistisia Frina Dinarsari, S.Farm., Apt.
</td>
<td>P</td>
<td>19860731/STRA-UNAIR/2010/218138</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1002</td>
<td>P-0318</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Slamet Riadi No.16, Banjaran, Kediri
</td>
<td>-</td>
<td>Mulyani, S.Farm., Apt.</td>
<td>P</td>
<td>19870626/SIKA-35.71/2012/2007</td>
<td>PBF</td>
<td>Jarot Santoso</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1003</td>
<td>P-0021</td>
td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Brigjen Katamso No.80, Kediri</td>
<td>-</td>
<td>L</td>
<td>446/916/419/412004</td>
<td>PBF</td>
<td>-</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1004</td>
<td>P-0453</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Dewi Sartika No.8-10, Kediri</td>
<td>-</td>
<td>Aroma Ocfi Dwi Hapsari, S.Farm., Apt.</t
d>
<td>P</td>
<td>19841011/STRA-UAD/2009/210908</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1005</td>
<td>P-0193</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Gatot Subroto No.153, Kediri</td>
<td>-</td>
<td>Lisa Iriani., S.Farm., Apt.</td>
<td>P</td>
<td>19861019/STRA-USB/2011/22466</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1006</td>
<td>P-0587</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Mayor Bismo No.229, Kediri</td>
<td>-</td>
<td>P</td>
<td>19880211/STRA-UNAIR/2011/23978</td>
<td>PBF</td>
<td>Arifudin</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1007</td>
<td></td>
<td>Andalas Putra Mandiri, PT</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Thamrin No.61, Madiun</td>
<td>-</td>
<td>P</td>
<td>PBF</td>
<td>-</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1008</td>
<td>P-1820</td>
td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Setiabudi No.10, Madiun</td>
<td>-</td>
<td>P</td>
<td>503/1972/401.103/AA.153/2010</td>
<td>PBF</td>
<td>-</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1009</td>
<td>P-0533</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Tanjung Raya No.42, Manisrejo, Madiu
n</td>
<td>-</td>
<td>Safrida Nugrahenny, S.Farm., Apt.</td>
<td>P</td>
<td>19850126/STRA-UBAYA/2009/222949</td>
<td>PBF</td>
<td>Henricus Setyo Jatmiko</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1010</td>
<td>P-0829</td>
>
<td>Cabang</td>
<td>-</td>
<td>Jl. Dr. Soetomo No.33, Madiun</td>
<td>-</td>
<td>Ninin Wahyuni, S.Farm., Apt.</td>
<td>P</td>
<td>503/870/401.103/SIKA.2/2012</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1011</td>
<td></td>

<td>Cabang</td>
<td>-</td>
<td>Jl. Manggar Manis No.3, Madiun</td>
<td>-</td>
<td>P</td>
<td>-</td>
<td>PBF</td>
<td>-</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1012</td>
<td>P-0098</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Yos Sudarso No.29-31, Madiun</td>
<td>-</td>
<td>Ana Faridha, S.Farm., Apt.</td>
<td>P</td>
<td>19870918/STRA-USB/2011/22400</td>
<td>PBF</td>
<td>Mahmudi</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1013</td>
<td></td>
<td>Sentrawaras Nusatama, PT</td>
<td>Pusat</td>
<td>HK.07.01/V/076/14</td>
<td>JL. Bali No. 20 Kota Madiun</td>
<td>0351-453223 / 451025</td>
<td>Abdul Hamid Irsyad, S.Si., Apt.</td>
<td>L</td>
<td>19800416/STRA-UHAMKA/2010/17980</td>
<td>PBF</td>
<td>drg. Lisawati</td>
<td></td>
<td>Aktif</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1014</td>
<td></td>
<td>Aloha Jaya, PT</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Suropati No.40, Malang</td>
<td>-</td>
<td>L</td>
<td>446.AA/258/K/35.73.306/2009</td>
<td>PBF</td>
<td>-</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1015</td>
<td>P-1376</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Baluran No.8, Malang</td>
<td>-</td>
<td>Nia Grahadian, S.Farm., Apt.</td>
<td>P</td>
<td>19850718/STRA-UGM/2009/222546</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1016</td>
<td>P-0117</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Simpang Ranugrati No.20, Malang</td>
<td>-</td>
<td>Ricka Priscillia, S.Farm., Apt.</td>
<td>P</td>
<td>19880710/STRA-UBAYA/2011/220550</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1017</td>
<td>P-0472</td>
<td>Cabang</td>
<td>-</td>
<td>-</td>
<td>Yuni Mariyana , S.Farm., Apt.</td>
<td>P</td>
<td>17/SIKA/35.73.306/2012</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1018</td>
<td>P-0478</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. A.Yani No.138, Malang</td>
<td>-</td>
<td>Pungki Kusuma Jayanti, S.Farm., Apt.</td
>
<td>P</td>
<td>19841107/STRA-UNAIR/2011/24003</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1019</td>
<td></td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Terusan Batubara No.30 C, Malang</td
>
<td>-</td>
<td>Nela Oktaviani, S.Farm., Apt.</td>
<td>P</td>
<td>19881011/STRA-UAD/2012/226237</td>
<td>PBF</td>
<td>Santoso</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1020</td>
<td>P-0462</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Kunir No.5, Malang</td>
<td>-</td>
<td>Dwi Prawita Widatama, S.Farm., Apt.</td>
<td>P</td>
<td>18/SIKA/35.73.306/2012</td>
<td>PBF</td>
<td>Harijono</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1021</td>
<td>P-0505</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Sunandar Priyo Sudarmo No.26, Malang
</td>
<td>-</td>
<td>Ratih Dewi Primahartutie, S.Farm., Apt.<
/td>
<td>P</td>
<td>15/SIKA/35.73.306/2012</td>
<td>PBF</td>
<td>Tavip Ismunandar</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1022</td>
<td>P-1650</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Tapak Liman No.15, Malang</td>
<td>-</td>
<td>P</td>
<td>PBF</td>
<td>-</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1023</td>
<td></td>
<td>Dwilandra Hida Utama, PT</td>
<td>Cabang</td>
<td>-</td>
<td>-</td>
<td>P</td>
<td>PBF</td>
<td>-</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1024</td>
<td></td>
<td>Gala Jaya Raya, PT</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Timah No.10, Malang</td>
<td>-</td>
<td>Sukarti</td>
<td>P</td>
<td>PBF</td>
<td>-</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1025</td>
<td></td>
<td>Graha Kandhi Farma, PT</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Cipunegara No.12, Malang</td>
<td>-</td>
<td>P</td>
<td>PBF</td>
<td>-</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1026</td>
<td></td>
<td>Great Mataram, PT</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Batanghari No.3, Malang</td>
<td>-</td>
<td>P</td>
<td>PBF</td>
<td>-</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1027</td>
<td></td>
<td>Hanjaya Perkasa Lestari Farma, PT</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Papandayan No.10, Malang</td>
<td>-</td>
<td>P</td>
<td>PBF</td>
<td>-</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1028</td>
<td>P-0102</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Soekarno Hatta No.80, Malang</td>
<td>-</td>
<td>Nurul Fitriyani, S.Farm., Apt.</td>
<td>P</td>
<td>19830703/STRA-USB/2011/22486</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1029</td>
<td></td>
<td>Cabang</td>
<td>-</td>
<td>-</td>
<td>Romdhoni, S.Farm., Apt.</td>
<td>L</td>
<td>19860603/STRA-UMS/2011/12328</td>
<td>PBF</td>
<td>Arief Priohutomo, ST</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1030</td>
<td>P-1840</td>
<td>Cabang</td>
<td>-</td>
</td>
<td>-</td>
<td>Herlina Septika, S.Farm., Apt.</td>
<td>P</td>
<td>19840717/STRA-UNAIR/2007/215343</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1031</td>
<td>P-1639</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Hamid Rusdi No.93, Malang</td>
<td>-</td>
<td>Esti Chandra Rini, S.Farm., Apt.</td>
<td>P</td>
<td>KP.01.03.1.3.3308</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1032</td>
<td>P-1169</td>
td>
<td>Cabang</td>
<td>-</td>
1/19, Malang</td>
<td>-</td>
<td>L</td>
<td>19860727/STRA-USB/2009/23506</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1033</td>
<td>P-0502</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Kebalen No.1B, Malang</td>
<td>-</td>
<td>P</td>
<td>-</td>
<td>PBF</td>
<td>-</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1034</td>
<td>P-1505</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Panji Suroso No.20, Malang</td>
<td>-</td>
.</td>
<td>P</td>
<td>18980723/STRA-UAD/2012/225747</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1035</td>
<td>P-0796</td>
<td>Cabang</td>
<td>-</td>
<td>-</td>
<td>Kartika Dewi Nastiti, S.Farm., Apt.</td>
<td>P</td>
<td>19890508/STRA-UAD/2012/228544</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1036</td>
<td>P-0518</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Karya Barat No.5, Malang</td>
<td>-</td>
<td>Angga Tan Satresna, S.Farm., Apt.</td>
<td>L</td>
<td>12/SIKA/35.73.306/2012</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1037</td>
<td>P-0742</td>
td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Hamid Rusdi No.95, Kec. Blimbing, Ma
lang</td>
<td>-</td>
<td>Ayu Andini Ibrahim, S.Farm., Apt.</td>
<td>P</td>
<td>19871219/STRA-UBAYA/2011/215661</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1038</td>
<td>P-0292</td>
<td>Cabang</td>
<td>-</td>
<td>-</td>
<td>Syahrial Fahrudin, S.Farm., Apt.</td>
<td>L</td>
<td>19851029/STRA-UAD/2010/16479</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1039</td>
<td>P-0220</td>
<td>Parit Padang Global, PT</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Tenaga Baru I No.11 A, Malang</td>
<td>-</td>
<td>P</td>
<td>19871211/STRA-UWM/2011/26193</td>
<td>PBF</td>
<td>Jauw Herry</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1040</td>
<td>P-0465</td>
<td>Cabang</td>
<td>-</td>
<td>-</td>
<td>Indah Purnama Dewi, S.Farm., Apt.</td>
<td>P</td>
<td>KP.01.03.1.3.1434</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1041</td>
<td>P-0528</td>
>
<td>Cabang</td>
<td>-</td>
<td>Jl. A.Yani Utara No.2, Malang</td>
<td>-</td>
<td>Sunarsih</td>
<td>P</td>
<td>PBF</td>
<td>-</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1042</td>
<td>P-0033</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Delima No.7, Malang</td>
<td>-</td>
<td>Dina Wifada, S.Farm., Apt.</td>
<td>P</td>
<td>19850709/STRA-UNAIR/2011/214064</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1043</td>
<td></td>
<td>Cabang</td>
<td>-</td>
>
<td>-</td>
<td>P</td>
<td>PBF</td>
<td>-</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1044</td>
<td></td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Topas No.18, Tlogomas Lowok Waru, Ma
lang</td>
<td>-</td>
<td>Perawati, S.Farm., Apt.</td>
<td>P</td>
<td>19850419/STRA-USB/2009/210086</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1045</td>
<td>P-0197</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Kyai Tamin No.15/I-J, Malang</td>
<td>-</td>
<td>Enggar Mardaresta, S.Farm., Apt.</td>
<td>P</td>
<td>19860307/STRA-USB/2009/215324</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1046</td>
<td></td>
<td>Savero Farma, PT</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Raya Dieng No.32, Malang</td>
<td>-</td>
<td>-</td>
<td>-</td>
<td>-</td>
<td>PBF</td>
<td>-</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1047</td>
<td></td>
<td>Sawah Besar Farma, PT</td>
<td>Cabang</td>
<td>-</td>
<td>-</td>
<td>P</td>
<td>PBF</td>
<td>-</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1048</td>
<td></td>
<td>Cabang</td>
<td>-</td>
<td>Pondok Blimbing Indah Utara Blok A6/19A,
RT/RW 11/05, Blimbing, Malang</td>
<td>-</td>
<td>Irfanto Hoesodo, S.Farm., Apt.</td>
<td>L</td>
<td>40/SIKA/35.73.306/2012</td>
<td>PBF</td>
<td>Yacobus Hendro Pranoto</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1049</td>
<td></td>
<td>Surya Prima Perkasa, PT</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Danau Toba , Ruko Sawojajar B2, Mala
ng</td>
<td>-</td>
<td>Vincent Amadeus Tutiz, S.Farm., Apt.</td
>
<td>L</td>
<td>60/SIKA/35.73.306/2015</td>
<td>PBF</td>
<td>Teguh Panca Widhiyanto</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1050</td>
<td></td>
<td>Tadjurputra Mandiri, PT</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Kesatrian Dalam No.22, Malang</td>
<td>-</td>
<td>Kartini</td>
<td>P</td>
<td>PBF</td>
<td>-</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1051</td>
<td>P-0035</td>
<td>Tempo, PT</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Raya Tlogo Mas No.26-27, Malang</td>
<td>-</td>
<td>Khoridah Septiningtyas, S.Farm., Apt.</t
d>
<td>P</td>
<td>19880913/STRA-UNAIR/2011/24046</td>
<td>PBF</td>
<td>Ai Ju, SE</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1052</td>
<td></td>
<td>Tunggal Sila Farma, PT</td>
<td>Cabang</td>
<td>-</td>
<td>-</td>
<td>P</td>
<td>PBF</td>
<td>-</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1053</td>
<td></td>
<td>Ultra Bintang Jaya Putra, PT</td>
<td>Cabang</td>
<td>-</td>
ang</td>
<td>-</td>
<td>Pusparini</td>
<td>P</td>
<td>PBF</td>
<td>-</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1054</td>
<td></td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Sonokembang No.12A, Malang</td>
<td>-</td>
<td>Masmariani, S.Si., Apt.</td>
<td>P</td>
<td>19681012/STRA-UWM/1994/24734</td>
<td>PBF</td>
<td>Suwarto</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1055</td>
<td>P-1442</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Nangka No.11, Malang</td>
<td>-</td>
<td>Febrind Chandikya Nuria Majid, S.Farm.,
Apt.</td>
<td>P</td>
<td>19870204/STRA-UMS/2011/16334</td>
<td>PBF</td>
<td>Faisal, ST</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1056</td>
<td></td>
<td>Usahatama Sentosa Mas, PT</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Halmahera No.68 B, Malang</td>
<td>-</td>
<td>Astu Sri Wulanti, S.Farm., Apt.</td>
<td>P</td>
<td>51/SIKA/35.73.306/2015</td>
<td>PBF</td>
<td>Ineke Indrijani</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1057</td>
<td></td>
<td>Wigo, PT</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. WR. Supratman No.6, Malang</td>
<td>-</td>
<td>P</td>
<td>PBF</td>
<td>-</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1058</td>
<td></td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Anggrek No.7, Probolinggo</td>
<td>-</td>
<td>Reta Djenis, S.Si., Apt.</td>
<td>P</td>
<td>19610210/STRA-UWM/1996/23793</td>
<td>PBF</td>
<td>Apeles Sugianto</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1059</td>
<td></td>
<td>Aditya Farmatama, PT</td>
<td>Cabang</td>
<td>-</td>
/td>
<td>-</td>
<td>P</td>
<td>PBF</td>
<td>-</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1060</td>
<td></td>
<td>Alvindo Juhan Lestari, PT</td>
<td>Pusat</td>
<td>HK.07.01/V/240/14</td>
<td>Jln. Raya Kalirungkut 1-3 Ruko Rungkut M
egah Raya Blok L 11-12, Surabaya</td>
<td>031-8781999</td>
<td>Elizabeth Juwita Lestari, S.Farm., Apt.<
/td>
<td>P</td>
<td>19900327/STRA-UBAYA/2013/233604</td>
<td>PBF</td>
<td>Winarto Djaya Purnama</td>
<td></td>
<td>Aktif</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1061</td>
<td></td>
<td>Al Kahfi, PT</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Ploso Baru No.190, Surabaya</td>
<td>-</td>
<td>P</td>
<td>PBF</td>
<td>-</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1062</td>
<td>P-0361</td>
T</td>
<td>Cabang</td>
<td>-</td>
<td>-</td>
<td>Vira Natalia Chendriawan, S.Farm., Apt.<
/td>
<td>P</td>
<td>KP.01.03.1.3.3375</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1063</td>
<td>P-0293</td>
T</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Putat Gede Indah No.2-A, Surabaya</t
d>
<td>-</td>
<td>Didit Pradipta, S.Farm., Apt.</td>
<td>L</td>
<td>19880506/SIKA-35.78/2012/1015</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1064</td>
<td></td>
<td>Anugerah Abi Farma, PT</td>

<td>Pusat</td>
<td>HK.07.01/V/229/13</td>
<td>Jl. Menur Pumpungan No. 76 Surabaya</td>
<td>031-5926025</td>
t.</td>
<td>P</td>
<td>19440719/STRA-UBAYA/1992/218796</td>
<td>PBF</td>
<td>Rohana, S.Sos.</td>
<td></td>
<td>Aktif</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1065</td>
<td>P-0119</td>
PT</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Klampis Jaya No.31 Blok J-K-L, Surab
aya</td>
<td>-</td>
<td>Meilia Puspita Sari., S.Farm., Apt.</td>
<td>P</td>
<td>19850507/STRA-UWM/2011/26219</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1066</td>
<td>P-0101</td>
PT</td>
<td>Cabang</td>
<td>-</td>
<td>-</td>
<td>Yoel Prawiro Christdian, S.Farm., Apt.</
td>
<td>L</td>
<td>19870106/SIKA-35.78/2012/2086</td>
<td>PBF</td>
<td>Untung Agusman</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1067</td>
<td>P-0341</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Berbek Industri I No.1 A, Surabaya</
td>
<td>-</td>
<td>Kiki Kulia Aulia Haqque, S.Farm., Apt.</
td>
<td>P</td>
<td>19860629/SIKA_3515/2012/2055</td>
<td>PBF</td>
<td>Joshijanto Tanuhadi</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1068</td>
<td></td>
<td>Asita Sukses Abadi Pharmindo, PT</td>
<td>Pusat</td>
<td>HK.07.01/V/573/13</td>
<td>Jl. Medokan Ayu MA.I / A-01, Surabaya.</
td>
<td>031-8795367</td>
<td>Sinta Kristianti, S.Farm., Apt.</td>
<td>P</td>
<td>19880113/STRA-UBAYA/2012/229912</td>
<td>PBF</td>
<td>Maria Marihani</td>
<td></td>
<td>Aktif</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1069</td>
<td></td>
<td>Astro Mega Farma, PT</td>
<td>Pusat</td>
<td>HK.07.01/V/467/12</td>
<td>Jl. Kendalsari Selatan No. 16, Surabaya<
/td>
<td>031-8715640</td>
<td>Andreas Jaya Hadikusuma, S.Farm., Apt.</
td>
<td>L</td>
<td>19870214/STRA-UNAIR/2012/18279</td>
<td>PBF</td>
<td>Liem Jo Ming</td>
<td></td>
<td>Aktif</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1070</td>
<td></td>
<td>Bakti Prima Sehati, PT</td>
<td>Pusat</td>
<td>HK.07.01/V/283/14</td>
<td>Jl. Semolowaru No. 112 Surabaya</td>
<td>031-5966186</td>
<td>Erni Gunawan, S.Si., Apt.</td>
<td>P</td>
<td>19740806/STRA-UGM/2000/214719</td>
<td>PBF</td>
<td>Sudirmanto</td>
<td></td>
<td>Aktif</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1071</td>
<td></td>
<td>Bhakti Guna Sarana, PT</td>
<td>Cabang</td>
<td>-</td>
<td>-</td>
<td>L</td>
<td>PBF</td>
<td>-</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1072</td>
<td>P-0393</td>
>
<td>Cabang</td>
<td>-</td>
<td>Jl. Raya Gubeng No.16, Surabaya</td>
<td>-</td>
<td>Noviane Tanzil, S.Farm., Apt.</td>
<td>P</td>
<td>19881102/STRA-UWM/2012/227473</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1073</td>
<td>P-0484</td>
>
<td>Cabang</td>
<td>-</td>
d>
<td>-</td>
<td>Diayu Desmar Dika, S.Farm., Apt.</td>
<td>P</td>
<td>19860704/STRA-UBAYA/2009/21189</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1074</td>
<td></td>
<td>Blessindo Farma, PT</td>
<td>Pusat</td>
<td>HK.07.01/V/463/14</td>
<td>Jl. Mayjen Soengkono Kompleks Wonokitri
<td>031-5673150, 5668509 / 5668523</td>
<td>Yuliani Lemantara, S.Si., Apt.</td>
<td>P</td>
<td>19760310/STRA-UWM/2004/222478</td>
<td>PBF</td>
<td>Noer Erniati Tampemawa</td>
<td></td>
<td>Aktif</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1075</td>
<td></td>
<td>Borwita Indah, PT</td>
<td>Pusat</td>
<td>HK.07.01/V/246/14</td>
<td>Jalan Kunir No. 9 Surabaya</td>
<td>031-3537445</td>
<td>Resti Kusumaningtyas, S.Farm., Apt.</td>
<td>P</td>
<td>19870925/STRA-UNUD/2012/229019</td>
<td>PBF</td>
<td>Hady Karyono</td>
<td></td>
<td>Aktif</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1076</td>
<td></td>
<td>Cahaya Alfa Farma, PT</td>
<td>Pusat</td>
<td>HK.07.01/V/567/14</td>
<td>Jl. Pucang Anom Timur I/33, Surabaya</td
>
<td>031-5010241</td>
<td>Erlena Yauwri, S.Farm., Apt.</td>
<td>P</td>
<td>19871022/STRA-UBAYA/2010/219063</td>
<td>PBF</td>
<td>Adriel Marcellus Enggai, S.Farm., Apt.</
td>
<td></td>
<td>Aktif</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1077</td>
<td></td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Gayungan PPN No.7, Surabaya</td>
<td>-</td>
<td>Linda Kusumawati, S.Farm., Apt.</td>
<td>P</td>
<td>19890610/STRA-UBAYA/2012/227121</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1078</td>
<td></td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Bibis No.14, Surabaya</td>
<td>-</td>
<td>Anita Tjahyono, S.Farm., Apt.</td>
<td>P</td>
<td>19840527/SIKA-35.78/2012/2118</td>
<td>PBF</td>
<td>Feby Feryansyah</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1079</td>
<td></td>
<td>Pusat</td>
<td>HK.07.01/V/152/12</td>
<td>Jl. Raya Kalirungkut No. 1-3 Blok N-12 K
omplek Ruko Megah Raya, Surabaya</td>
<td>031-8791211</td>
<td>Novita Kusuma Dewi, S.Farm., Apt.</td>
<td>P</td>
<td>19901121/STRA-UBAYA/2014/237705</td>
<td>PBF</td>
<td>Djoko Lasmono</td>
<td></td>
<td>Aktif</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1080</td>
<td></td>
<td>Datheo Pharma, PT</td>
<td>Pusat</td>
<td>HK.07.01/V/118/13</td>
td>
<td>031-8495533</td>
<td>Yohans Putra Pramana, S.Farm., Apt.</td>
<td>L</td>
<td>19870330/STRA-UWM/2011/11654</td>
<td>PBF</td>
<td></td>
<td>Aktif</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1081</td>
<td></td>
<td>Dayaanugerah Dewatasakti, PT</td>
<td>Pusat</td>
<td>HK.07.01/V/099/13</td>
<td>Jl. Taman Jemursari Selatan I/7 Surabaya
.</td>
<td>031-8410671, 8431152 / 8432108</td>
<td>Yunita Andri Mawarti, S.Farm., Apt.</td>
<td>P</td>
<td>19890625/STRA-UNAIR/2013/233049</td>
<td>PBF</td>
<td>M.N. Soeyani, SH</td>
<td></td>
<td>Aktif</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1082</td>
<td>P-0513</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Margorejo Indah No.28, Surabaya</td>
<td>-</td>
<td>Anita Puspasari, S.Farm., Apt.</td>
<td>P</td>
<td>19830128/SIKA-35.78/2015/2197</td>
<td>PBF</td>
<td>Arif Sofian Tedja</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1083</td>
<td>P-0526</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Margorejo Indah No.8-12, Surabaya</t
d>
<td>-</td>
<td>Afaf Abdul Karim,S.Farm, Apt.</td>
<td>L</td>
<td>19861105/STRA-UBAYA/2009/221119</td>
<td>PBF</td>
<td>Ng. Hok Lung</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1084</td>
<td></td>
<td>Ednu Surya, PT</td>
<td>Pusat</td>
<td>HK.07.01/V/265/14</td>
<td>Jl. Nginden Intan Raya 29 Surabaya</td>
<td>031-5991440</td>
<td>Amanda Nur Aini, S.Farm., Apt</td>
<td>P</td>
<td>19860421/STRA-UBAYA/2011/216952</td>
<td>PBF</td>
<td>Edward</td>
<td></td>
<td>Aktif</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1085</td>
<td></td>
<td>Effata Fajar Anugerah, PT</td>
<td>Pusat</td>
<td>HK.07.01/V/053/13</td>
<td>Jl. Rungkut Asri Barat I/25 RT.001/RW.01
2, Kel. Rungkut Kidul, Kec. Rungkut</td>
<td>031-8782977 / 8782955</td>
<td>Renata Andari, S.Farm., Apt.</td>
<td>P</td>
<td>19911207/STRA-UBAYA/2014/235671</td>
<td>PBF</td>
<td></td>
<td>Aktif</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1086</td>
<td></td>
<td>Eka Anjaya Abadi, PT</td>
<td>Pusat</td>
<td>HK.07.01/V/337/14</td>
<td>Jl. Lebak Arum IV No. 24, Surabaya </td>
<td>031-3893744, 3896259/3818650</td>
<td>Fillicya Thelvyanthie, S.Farm., Apt.</td
>
<td>P</td>
<td>19870913/STRA-UWM/2012/227494</td>
<td>PBF</td>
<td>Mulyono Wijaya</td>
<td></td>
<td>Aktif</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1087</td>
<td>P-0538</td>
<td>Enseval Putera Megatrading Tbk Cabang Su
rabaya 2, PT</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Raya Kendangsari No.45-47, Surabaya<
/td>
<td>-</td>
<td>Yunita Irwanto, S.Farm., Apt.</td>
<td>P</td>
<td>19830607/SIKA-35.78/2012/2010</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1088</td>
<td></td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Kutisari Utara VII/18, Surabaya</td>
<td>-</td>
<td>Khoirun Nisa, S.Farm., Apt.</td>
<td>P</td>
<td>19880818/STRA-UAD/2011/24157</td>
<td>PBF</td>
<td>Suyanto</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1089</td>
<td>P-0111</td>
<td>Gelora Fajar Farma, PT</td>
<td>Cabang</td>
<td>-</td>
td>
<td>-</td>
<td>Elok Tri Handayani, S.Farm., Apt.</td>
<td>P</td>
<td>19881021/SIKA-35.78/2015/2188</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1090</td>
<td>P-0221</td>
<td>Global Persada Farma, PT</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Kaliwaron No.136, Surabaya</td>
<td>-</td>
<td>P</td>
<td>19870627/STRA-UWM/2010/212801</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1091</td>
<td></td>
<td>Graha Farma Lestari, PT</td>
<td>Pusat</td>
<td>HK.07.01/V/490/14</td>
<td>031-911156, 5966688</td>
<td>Kinanthi Pasissa Puspita Sari, S.Farm.,
Apt.</td>
<td>P</td>
<td>19901219/STRA-UNAIR/2013/233142</td>
<td>PBF</td>
<td>M. Farchan</td>
<td></td>
<td>Aktif</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1092</td>
<td>P-0847</td>
<td>Gratia Jaya Farma, PT</td>
<td>Cabang</td>
<td>-</td>
<td>-</td>
<td>Anissa Irmania Utami, S.Farm., Apt.</td>
<td>P</td>
<td>19900712/SIKA-35.78/2015/2227</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1093</td>
<td>P-0625</td>
<td>Cabang</td>
<td>-</td>
Surabaya</td>
<td>-</td>
<td>Fitrieny Namelia, S.Farm., Apt.</td>
<td>P</td>
<td>19830506/STRA-UGM/2008/214695</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1094</td>
<td></td>
<td>Johnson & Johnson Indonesia, PT</td>
<td>Pusat</td>
<td>HK. 07.01/V/466/12</td>
<td>K-LINK Tower Lt. 12 Jl. Jend. Gatot Subr

oto Kav. 59A, Kuningan Timur, Setiabudi</td>
<td>-</td>
<td>Tengku Vannesa Rilviena, S.Farm., Apt.</
td>
<td>P</td>
<td>19890611/STRA-UNPAD/2012/228072</td>
<td>PBF</td>
<td>Indriyati Sumarsono</td>
<td></td>
<td>Aktif</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1095</td>
<td>P-0944</td>
<td>Cabang</td>
<td>-</td>
</td>
<td>-</td>
<td>Wahid Bekti Fitrianto, S.Farm., Apt.</td
>
<td>L</td>
<td>19860626/STRA-UMS/2011/12327</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1096</td>
<td></td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Biliton No.14, Surabaya</td>
<td>-</td>
<td>Yuliana Hidayat, S.Farm., Apt.</td>
<td>P</td>
<td>19870719/STRA-UWM/2011/26222</td>
<td>PBF</td>
<td>Sugeng Santoso, SE.</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1097</td>
<td>P-0530</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Gubeng Pojok No.25, Surabaya</td>
<td>-</td>
<td>Selvi Widya Astuti, S.Farm., Apt.</td>
<td>P</td>
<td>19870912/STRA-UWM/2011/29848</td>
<td>PBF</td>
<td>Januri Purwanto</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1098</td>
<td></td>
<td>Kijang Mas Jaya, PT</td>
<td>Pusat</td>
<td>HK.07.01/V/019/15</td>
<td>Jl. Sidorame 2 B, Surabaya</td>
<td>031-3767086 / 3721536</td>
<td>Roshalima, S.Farm., Apt.</td>
<td>P</td>
<td>19890128/STRA-UNAIR/2012/228834</td>
<td>PBF</td>
<td>DR. Tirto Wardono</td>
<td></td>
<td>Aktif</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1099</td>
<td>P-0515</td>
td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Raya Jemursari No.41, Surabaya</td>
<td>-</td>
<td>Ayek Dwi Rosiana, S.Farm., Apt.</td>
<td>P</td>
<td>19880404/STRA-UNAIR/2011/24022</td>
<td>PBF</td>
<td>Drs. Lontung Sinaga, Apt.</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1100</td>
<td></td>
<td>Pusat</td>
<td>HK.07.01/V/235/14</td>
<td>Jl. Kencanasari Timur VIII/H-1 Surabaya<
/td>
<td>031-5680230,5672591 / 5678598</td>
<td>Donnie Andreas, S.Farm., Apt.</td>
<td>L</td>
<td>19850416/STRA-UNAIR/2012/18278</td>
<td>PBF</td>
<td>Drs. Paulus Totok Lusida, Apt.</td>
<td></td>
<td>Aktif</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1101</td>
<td>P-1465</td>
PT</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Jaksa Agung Suprapto No.19, Surabaya
</td>
<td>-</td>
<td>Lisa Arianto, S.Farm., Apt.</td>
<td>P</td>
<td>19870704/STRA-UWM/2010/214758</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1102</td>
<td>P-1514</td>
PT</td>
<td>Cabang</td>
<td>-</td>
>
<td>-</td>
<td>Yuliana, S.Farm., Apt.</td>

<td>P</td>
<td>19881207/STRA-UBAYA/2011/222303</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1103</td>
<td>P-2077</td>
PT</td>
<td>Cabang</td>
<td>-</td>
<td>Raya Manukan Wetan No.14, RT/RW 01/01, M
anukan Wetan, Tandes, Surabaya</td>
<td>-</td>
<td>Ferdi Dwi Janarto, S.Farm., Apt.</td>
<td>L</td>
<td>19880509/STRA-UNAIR/2011/10994</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1104</td>
<td>P-1283</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Mojoklanggru Lor No.227, Surabaya</t
d>
<td>-</td>
<td>Ong Henny Kusumawaty, S.Farm., Apt.</td>
<td>P</td>
<td>19871124/STRA-UBAYA/2011/218822</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1105</td>
<td>P-0525</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Darmokali No.32, Surabaya</td>
<td>-</td>
<td>Sonya Trisnowati, S.Farm., Apt.</td>
<td>P</td>
<td>19841114/SIKA-35.78/2012/2060</td>
<td>PBF</td>
<td>Sunardi</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1106</td>
<td>P-0522</td>
td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Kalibokor Selatan No.152, Surabaya</
td>
<td>-</td>
<td>Wulan Nawangsari, S.Farm., Apt.</td>
<td>P</td>
<td>19800920/SIKA-35.78/2012/2027</td>
<td>PBF</td>
<td>Wijarnako</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1107</td>
<td></td>
<td>Mitra Sumber Abadi, PT</td>
<td>Pusat</td>
<td>HK.07.01/V/239/14</td>
<td>Jl. Raya Darmo Permai Selatan Ruko Sentr
a Darmo Villa Blok B-15, Surabaya</td>
<td>031-7321061</td>
<td>Janti Dwisiani Pramana, S.Farm., Apt.</t
d>
<td>P</td>
<td>19860127/STRA-UWM/2009/214749</td>
<td>PBF</td>
<td>Franky Aryanto Goenawan, ST</td>
<td></td>
<td>Aktif</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1108</td>
<td>P-0503</td>
<td>Cabang</td>
<td>-</td>
<td>-</td>
<td>P</td>
<td>-</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1109</td>
<td></td>
<td>Panca Pilar Tangguh, PT</td>
<td>Pusat</td>
<td>HK.07.01/V/378/14</td>
<td>Jl. Kalianget No. 100 Surabaya</td>
<td>031-3285277</td>
<td>Rachma Dessidianti, S.Farm., Apt.</td>
<td>P</td>
<td>19881209/STRA-UNAIR/2012/225612</td>
<td>PBF</td>
<td>Winarto Wijono</td>
<td></td>
<td>Aktif</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1110</td>
<td>P-2089</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Rungkut Industri III No.32, Surabaya
</td>
<td>-</td>
<td>Paul Octavianus, S.Farm., Apt.</td>
<td>L</td>
<td>19871015/STRA-UBAYA/2011/15347</td>
<td>PBF</td>
<td>Binsar Sitorus</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1111</td>
<td>P-0260</td>
T</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Tumapel No.10 A-12, Surabaya</td>
<td>-</td>
<td>Puspita Mayasari Sutanto, S.Farm., Apt.<
/td>
<td>P</td>
<td>19851117/STRA-UBAYA/2009/218770</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1112</td>
<td>P-0674</td>
T</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Rungkut Industri I No.19, Surabaya</
td>
<td>-</td>
<td>Feronika Rasubala , S.Farm., Apt.</td>
<td>P</td>
<td>KP.01.03.1.3.1752</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1113</td>
<td></td>
>
<td>Cabang</td>
<td>-</td>
<td>Jl. Rajawali No.54, Surabaya</td>
<td>-</td>
<td>P</td>
<td>-</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1114</td>
<td></td>
<td>Pierosca Terang Sukses Abadi, PT</td>
<td>Pusat</td>
<td>HK.07.01/V/098/13</td>
td>
<td>031-7340745</td>
<td>Ivan Putra Sindarto, S.Farm., Apt.</td>
<td>L</td>
<td>19900326/STRA-UBAYA/2014/110951</td>
<td>PBF</td>
<td></td>
<td>Aktif</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1115</td>
<td></td>
<td>Podo Mekar Jaya Sentosa, PT</td>
<td>Pusat</td>
<td>HK.07.01/V/272/13</td>
<td>Jl. Kalisari III/17B Surabaya</td>
<td>031-5321212, 5325151, 5464666, 5475252 /
5470909, 5313121</td>
<td>Ma'rifatus Sholecha, S.Farm., Apt.</td>
<td>L</td>
<td>19900514/STRA-UNAIR/2014/235145</td>
<td>PBF</td>
<td></td>
<td>Aktif</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1116</td>
<td></td>
<td>Primaputra Megahsejati, PT</td>
<td>Pusat</td>
<td>HK.07.01/V/437/14</td>
<td>Jl. Joyoboyo No. 12 Surabaya</td>
<td>031-5676680/5688375</td>
<td>Antonius, S.Farm., Apt.</td>
<td>L</td>
<td>19881004/STRA-UWM/2012/18658</td>
<td>PBF</td>
<td>Lucyani</td>
<td></td>
<td>Aktif</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1117</td>
<td></td>
<td>Procter & Gamble Home Products Indonesia
, PT</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Kalianak Barat Raya No.66, Surabaya<
/td>
<td>-</td>
<td>Luisa Pasadena, S.Farm., Apt.</td>
<td>P</td>
<td>KP.01.03.1.3.1017</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1118</td>
<td>P-0023</td>
td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Kalimas Barat No.35-37, Surabaya</td
>
<td>-</td>
<td>Riza Ariesta Hellinda, S.Farm., Apt.</td
>
<td>P</td>
<td>19860413/SIKA-35.78/2012/2079</td>
<td>PBF</td>
<td>Drs. Bones Sembiring</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1119</td>
<td>P-0027</td>
td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Raya Tenggilis No.101, Surabaya</td>
<td>-</td>
<td>Agustina Eka Puspitasari, S.Farm., Apt.<
/td>
<td>P</td>
<td>19840811/SIKA-35.78/2012/2049</td>
<td>PBF</td>
<td>Soepomo, SE</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1120</td>
<td></td>
<td>Rapedian Nusantara, PT</td>
<td>Pusat</td>
<td>HK.07.01/V/247/14</td>
<td>Jl. Kalibokor No. 33 Surabaya</td>
<td>031-5018001, 5019186 / 5019187</td>
<td>Rerie Oktaviani, S.Farm., Apt.</td>
<td>P</td>
<td>19891020/STRA-UBAYA/2012/229910</td>
<td>PBF</td>
<td>M.J. Okky Tayu</td>
<td></td>
<td>Aktif</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1121</td>
<td>P-0093</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Dukuh Pakis No.11, Surabaya</td>

<td>-</td>
<td>Nining Hari Murti Wijaya, S.Farm., Apt.<
/td>
<td>P</td>
<td>19800920/STRA-UII/2005/220657</td>
<td>PBF</td>
<td>Motoh Elfian Nolly</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1122</td>
<td>P-0099</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Kedung Cowek No.175, Surabaya</td>
<td>-</td>
<td>Veronica Krisnawan, S.Farm., Apt.</td>
<td>P</td>
<td>KP.00.03.1.3.2093</td>
<td>PBF</td>
<td>Leni</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1123</td>
<td></td>
<td>Sejahtera Surya Intrio, PT</td>
<td>Pusat</td>
<td>HK.07.01/V/366/13</td>
<td>Jl. Ngagel Jaya Utara 106, Surabaya</td>
<td>031-5014086 / 5028422</td>
<td>Marlina Thie, S.Farm., Apt.</td>
<td>P</td>
<td>19890314/STRA-UWM/2013/231533</td>
<td>PBF</td>
<td>Alfrin Yunarso</td>
<td></td>
<td>Aktif</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1124</td>
<td></td>
<td>Selaras Kusuma, PT</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Manyar Kertoadi No.95, Surabaya</td>
<td>-</td>
<td>Rizky Perdana, S.Farm., Apt.</td>
<td>L</td>
<td>19880323/SIKA-35.78/2012/2054</td>
<td>PBF</td>
<td>Guwijanto</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1125</td>
<td>P-0501</td>
<td>Cabang</td>
<td>-</td>
td>
<td>-</td>
<td>Aina Mujtahida Alwan, S.Farm., Apt.</td>
<td>P</td>
<td>19861218/SIKA-35.78/2011/2003</td>
<td>PBF</td>
<td>Harijanto Tanuadisupena</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1126</td>
<td></td>
<td>Tempo, PT</td>
<td>Pusat</td>
<td>HK. 07.01/V/339/12</td>
<td>Jl. Raya Sultan Agung KM. 28 Pondok Ungu
, Medan Satria, Kota Bekasi.</td>
<td>021-29218888 </td>
<td>Meta Nobelia Hapsari, S.Farm., Apt</td>
<td>P</td>
<td>19910518/STRA-UGM/2013/232702</td>
<td>PBF</td>
<td>Suryadi Nagawiguna</td>
<td></td>
<td>Aktif</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1127</td>
<td>P-0149</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Rungkut Industri III No.11, Surabaya
</td>
<td>-</td>
<td>Suryani Widya Oktavia, S.Farm., Apt.</td
>
<td>P</td>
<td>1989001/STRA-UWM/2011/26237</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1128</td>
<td>P-0241</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Gemblongan No.73, Surabaya</td>
<td>-</td>
<td>Nurul Qomariyah, S.Farm., Apt.</td>
<td>P</td>
<td>19831128/STRA-UNAIR/2007/27009</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1129</td>
<td>P-2075</td>
<td>Cabang</td>
<td>-</td>
>
<td>-</td>
<td>Dra. Elisabeth Swandayani, Apt.</td>
<td>P</td>
<td>-</td>
<td>PBF</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
<tr>
<td>1130</td>
<td>P-1202</td>
<td>Cabang</td>
<td>-</td>
<td>Jl. Jagiran No.76 Sby</td>
<td>-</td>
<td>Wulan Wiranti, S.Farm., Apt.</td>
<td>P</td>
<td>KP.01.03.1.3.5893</td>
<td>PBF</td>
<td>Darmanto</td>
<td></td>
<td>-</td>
<td>-</td>
<td>A</td>
<td>2014</td>
</tr>
</table>
</body>

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<h3>DAFTAR SARANA PEDAGANG BESAR FARMASI (PBF) <br />

<td>Jl. Raya Kapas 53 Bojonegoro</td>

na Sukma Lestari </td>

<td>YF.05.DJ.I.PBF.477 14 Juli 2006</td>

<td>351117/PBF/IV/99 22 April 1999</td>

sen Jiwan Madiun</td>

<td>Neneng Yuliana </td>

<td>Jl. Sultan Agung no.12 Malang</td>

<td>KEBAYORAN FARMA CAB MALANG PT</td>

<td> 446.AA/196/SIK/35 73.306/2008</td>

<td>Jl. Citarum no. 5 Malang</td>

<td>REJEKI MITRA FARMA PT</td>

<td>P2T/2/03.11/V/2010 3 Mei 2010</td>

<td>ANJASMORO INDAH PT</td>

<td>Jl. Margomulyo Industri IV Blok G No.14

<td>Marietta Angeline Dian Soeheningsih </td

<td>Jl. Pucang Anom Timur No.34

<td>Ike Nur Fitriana, S.Farm., Apt</td>

<td>Perum Nyalabu Indah Blok D No. 1, Pameka

<td>PT. Sun Hodos</td>

<td>Yayik Dwi Primadani, S.Farm., Apt</td>

<td>Jl. A.Yani No. 138, Malang</td>

<td>PT. Perusahaan Perdagangan Indonesia</td

<td>PT. Dalan Triputra Mandiri</td>

<td>Jl. Manyar Kartika Vii No 10,12,14,16 Me

<td>PT. Rajawali Nusindo Cabang Surabaya 2</

<td>Jl. Mayjen Sungkono Wonokitri Indah S/33

<td>PT. Astakarya Cipta Mandiri</td>

<td>Kompleks Pertokoan Villa Bukit Mas Blok

<td>PT. Effata Fajar Anugerah</td>

<td>Dra. Rina Surjani Purwadipura, M.Si., Ap

<td>Mitra Pharmindo Sejati, PT</td>

<td>Jl. Sentot Prawirodirjo No. 30, Jember</

<td>Masita Rinaldia, S.Farm., Apt.</td>

<td>Damai Sejahtera Pharma, PT</td>

<td>Ruko Tanrise Central Square Blok C-12,Jl

<td>Kompleks Gudang West Gate B-19, Gedangan

<td>Junger Farma, PT</td>

<td>Abdul Hamid Irsyad, S.Si., Apt.</td>

<td>Lady Pharmindo, PT</td>

<td>Tri Indah Nuryanti</td>

<td>Jl. Raya Tlogo Mas No. 26-27, Malang</td

<td>Esti Chandra Rini, S.Farm, Apt</td>

<td>Bintang Utama Inti, PT</td>

<td>Jl. Sulung Sekolagan No. 2 D-E, Surabaya

<td>Rio Farma, PT</td>

<td>Moch. Noerhadi Soeyani, SH</td>

<td>Veronica Krisnawan, S.Farm., Apt</td>

<td>Parit Padang Global Cabang Surabaya 1, P

<td>Junger Farma Distribusi, PT</td>

<td>Maulidia Rahmani, S.Farm., Apt.</td>

<td>Merapi Utama Pharma, PT</td>

<td>Dewi Ari Sandi, S.Farm., Apt</td>

<td>Dempo Sentosa, PT</td>

<td>Penta Valent, PT</td>

<td>Pharmindo Rimpang Kokoh, PT</td>

<td>Anugerah Abi Farma, PT</td>

<td>K-LINK Tower Lt. 12 Jl. Jend. Gatot Subr

<td>Yuliana, S.Farm., Apt.</td>

<td>Jl. Dukuh Pakis No.11, Surabaya</td>

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