IKATAN APOTEKER INDONESIA

PENGURUS CABANG KABUPATEN KAPUAS

PROPINSI KALIMANTAN TENGAH
Sekretariat : RSUD. Dr. H. SOEMARNO SOSROATMODJO
JL. TAMBUN BUNGAI NO. 16 TELP. 0513-21653 FAX. 0513-23791
KABUPATEN KAPUAS – KALIMANTAN TENGAH

DAFTAR ANGGOTA
IKATAN APOTEKER INDONESIA KUALA KAPUAS

NO NAMA NO TELP STATUS NIP PANGKAT/GOL/J EMAIL TEMPAT/TGL LULUSAN/T NO NO STRA NO SIPA NO SIA TEMPAT
ABATAN LAHIR HN KOMPETENSI PRAKTEK

503.7/00007/K
ESRA- IFRS
BPPT/2016 KAPUAS
19640423.199312. PEMBINA, IV A, Pematangbandar, Univ. 00.00381/PP.IAI 19640423/STRA-
1 EDEL SITORUS, M.Si., Apt 081349121945 PNS 1.001 APOTEKER edelsitorus64@gmail.com 23 April 1964 Sumatera /IV/2016 USU/1993/15110
MADYA Utara/1993
503.B11/2/DP 503.B.13/2/DP
MDPTSP- MPTSP- APOTEK
3/2017 03/2017 WARAS

19820822.201101. PENATA, III C, aquarina.rsudkps@gm Terusan Karya, 22 00.00382/PP.IAI 19820822/STRA- 503.7/00011/K 503.12/00009/ APOTEK
2 AQUARINA, S.Farm., Apt 085228290200 PNS 2.004 APOTEKER ail.com Agustus 1982 USD/2009 /IV/2016 USD/2009/21788 ESRA- KESRA- SELARAS
MUDA 1 BPPT/2016 BPPT/2016

503.B13/4/DP APOTEK
3 ASITA, S.Farm., Apt 085248199939 SWASTA asitabjm25@gmail.com Banjarmasin, 20 UMS/2015 14.0849/PP.IAI/ 19920720/STRA- 503.B11/4/DP MPTSP- TANTOWI
Juli 1992 III/2015 UMS/239508 MPTSP-3/2017 03/2017 99

Banjar, 17 Feb 22.0155/PP.IAI/ 19830217/STRA- 503/00004/KE 503.12/00003/ APOTEK

4 AULIA AZIZAH, S.Farm., Apt 085651030421 SWASTA auliaazizah172gmail.com 1983 UMS/2006 IX/2011 UMS/2006/21513 SRA- KESRA- SEJAHTERA
0 BPPT/2013 BPPT/2013

PENATA TK.1, III 19821005/STRA.

19821005.200802. D, APOTEKER abhinayazuna@gmail.comKuala Kapuas, 05 21.0116/PP.IAI/ UAD/2015/21788
5 EKA PUJI ASTUTI, S.Far., Apt 082153484442 PNS 2.001 Oktober 1982 UAD/2007 XII/2013
MUDA 4
 19870721/STRA- 503.12/00002/
6 EKA PUJI LESTARI, S.Farm., Apt 082134434193 SWASTA ekalestari_kapuas@ya Pulang Pisau, 21 UMS/2012 21.0036/PP.IAI/ UMS/2012/22632 503.B11/7/DP KESRA- APOTEK
hoo.co.id Juli 1987 V/2017 0 MPTSP-3/2017 BPPT/2016 SIAGA

Kuala Kapuas, 22 14.9117/PP.IAI/ 19890422/STRA- 503.7/00005/K 503.12/00004/ APOTEK

7 HARIANTO, M.Pharm., Apt 085249229525 SWASTA ariventolin22@gmail.com April 1989 USB/2013 X/2013 USB/2013/19850 ESRA- KESRA- SEDERHAN
BPPT/2016 BPPT/2016 A

PENATA, III C, 19801130/STRA- 503.7/00010/K 503.12/00007/

8 HERNI MULIANI, S.Farm., Apt 081348959979 PNS 19801130.200903. APOTEKER Cirebon, 30 UGM/2006 00.00390/PP.IAI UGM/2006/2178 ESRA- KESRA- APOTEK
2.002 MUDA November 1980 /IV/2016 83 BPPT/2016 BPPT/2016 MUJARAB

081215795514 19860210.201101. PENATA, III C, nha_aptio@yahoo.co.i Kuala Kapuas, 10 22.0033/PP.IAI/ 19860210/STRA- 503.7/00002/K 503.12/00006/ APOTEK
9 IBNA RUSMANA, S.Far., Apt 4 PNS 2.003 APOTEKER d Februari 1986 UAD/2010 XII/2014 UAD/2010/21788 ESRA- KESRA- PRIMA
MUDA 2 BPPT/2016 BPPT/2014

19911112/STRA- 503.B11/3/DP 503.B.13/5/DP APOTEK

10 IWAN YUWINDRY, M.Farm., Apt 081226922221 SWASTA iwanyuwindry@gmail.comKuala Kapuas, 12 14.1839/PP.IAI-
USB/2017 APTF1/III/2017 USB/2017/11404 MKPTSP- MPTSP- HIJAU
November 1991 5 3/2017 03/2017 DAUN

11 JOKO PRIYANTO WIBOWO, M.Si, Apt 081351313941 SWASTA jp.wibowo@yahoo.co.i Sragen, 06 USB/2008
d Desember 1984

MAHARANI RUKMANA PRAHESTI, Pulau Mambulau, 12.2555/PP.IAI- 19920407/STRA- 503.B11/5/DP 503.B13/6/DP APOTEK
12 S.Farm., Apt 082148025177 SWASTA prahestimaharanirukmana@gmail.com
7 April 1992 2017 APTFI/IV/2017 ISTN/2017/24997 MPTSP-3/2017 MPTSP- NURUL
4 03/2017 HASANAH

503/00003/KE 503.12/00001/
13 MAYA SCORVIYANTI, S.Farm., Apt 085292910004 SWASTA mscorviyanti@gmail.c Belingu Bangka, 23 UII/2012 15.5892/PP.IAI/ 19871023/STRA- SRA- KESRA- APOTEK
om Oktober 1987 IX/2012 UII/2012/229146 BPPT/2014 BPPT/2014 QOLBI

merynorvisari@gmail.c Palangkaraya, 31 22.0041/PP.IAI/ 19870331/STRA. 503.7/00012/K 503.12/00010/ APOTEK

14 MERY NORVISARY, S.Farm., Apt 085229249879 SWASTA om Maret 1987 UMS/2010 XII/2014 UMS/2010/21788 ESRA- KESRA- ALAMI
6 BPPT/2016 BPPT/2016

almira.miaty@gmail.co Kuala Kapuas, 01 00.1039/PP.IAI/ 19880501/STRA-

15 MIATY ALMIRA, S.Farm., Apt 081229418885 SWASTA m Mei 1988 UII/2010 VIII/2016 UII/2010/217887

19920402/STRA-
16 RENNY FEBRIANTY, S.Farm., Apt 081221755795 SWASTA rennkim92@gmail.com Kuala Kapuas, 02 USB/2017 14.1876/PP.IAI- USB/2017/24828
April 1992 APTFI/III/2017 3

Palangkaraya, 02 15.0304/PP.IAI/ 19900102/STRA- 503.7/00007/K 503.12/00006/ APOTEK

17 RESTU ASHA FAUZANA, S.Farm., Apt 085391162225 SWASTA restuasha@gmail.com Juni 1990 UAD/2011 VIII/2014 UAD/2014/23691 ESRA- KESRA- ASHA AS-
4 BPPT/2016 BPPT/2015 SYIFA
 19720712/STRA- 503.7/00015/K 503.12/00005/
18 RIBKA PALLANGAN, S.Si., Apt 081348602050 PNS ribkapallangan@yahoo Soroako. 12 Juli UNHAS/19 00.6754/PP.IAI/ UNHAS/1999/127 ESRA- KESRA- APOTEK
.co.id 1972 99 V/2016 877 BPPT/2016 BPPT/2014 BUDI

Banjarmasin, 21 22.0054/PP.IAI/ 19870921/STRA- 503.7/00008/K 503.12/00005/ APOTEK

19 RISKAN NOOR, S.Farm., Apt 08195123444 SWASTA riskannoor@yahoo.co.id September 1987 UII/2011 XII/2014 UII/2011/16007 ESRA- KESRA- AL-NOOR
BPPT/2016 BPPT/2016

19890512/STRA- 503/00010/KE 501.12/00004/ APOTEK

20 SAMSURI, S.Farm., Apt 082276958855 SWASTA samsurie12@gmail.co Jakarta, 12 Mei UHAMKA/2 12.0124/PP.IAI/ UHAMKA/2014/1 SRA- KESRA- KIMIA
m 1989 014 IV/2014 1042 BPPT/2014 BPPT/2014 FARMA

Kuala Kapuas, 14 14.9154/PP.IAI/ 19910314/STRA- 503.7/00009/K 503.12/00006/ APOTEK

21 SHELA PUZI DINA, M.Farm., Apt 082323476769 SWASTA sellapuzi@gmail.com Maret 1991 USB/2013 X/2013 USB/2013/23418 ESRA- KESRA- SHELA
5 BPPT/2016 BPPT/2016

19891028/STRA/ 503.B11/09/D
Leksula, 28 14.0051/PP.IAI/ USB/2014/23573 PMPTDP- APOTEK
22 SUCIATY ZAINUDDIN, M.Farm., Apt 082191144422 SWASTA suciaty_zainuddin@yahoo.com
Oktober 1989 2014 III/2014 LARIS
9 03/2017

19811210/STRA- 503.7/00016/K 503.B13/3/DP

23 WIWIN INDRIASTUTI, S.Farm., Apt 085259708888 SWASTA murah.kapuas@gmail.comBanjarmasin, 10 UBAYA/200 16.8413/PP.IAI/ UBAYA/2004/217 ESRA- MPTSP- APOTEK
Desember 1981 4 X/2013 885 BPPT/2016 03/2017 MURAH

yusri23jauhari@gmail. Sleman, 23
24 YUSRI KURNIA JAUHARI, S.Farm., Apt 081351313940 PNS com September 1984 USB/2007

Drs. Edel Sitorus, M.Si., Apt Aquarina, S.Farm., Apt

Ketua Sekretaris
 IKATA
PENGU
PRO
Sekretariat : R
JL. TAMBUN BU
KABUPATEN

DATA
Kota/Kabu
No Nama Sarana Alamat Sarana paten

1 IFRS KAPUAS Jln. Tambun Bungai No 16 Kapuas

2 APOTEK ALAMI Jln. Mawar Ruko 7 Blok 1 Kapuas

Jln. Seroja RT. 34 RW. 004, Selat

3 APOTEK AL-NOOR Kapuas
Tengah, Selat

4 APOTEK ASHA AS-SYIFA Jln. Melati No 13 Kapuas

5 APOTEK BERKAH

6 APOTEK BUDI Jln. Mawar No 102 Kapuas

7 APOTEK KIMIA FARMA Jln. Ahmad Yani No 49 Selat Hilir, Selat Kapuas

8 APOTEK LARIS Jln. Anggrek No 2 Selat Tengah, Selat Kapuas

Jln. Tambun Bungai No 16B, Selat

9 APOTEK MUJARAB Kapuas
Tengah

10 APOTEK MURAH Jln. Tambun Bungai No 14 Kapuas

APOTEK NURUL
11 Jln. Teratai No 16 Selat Tengah, Selat Kapuas
HASANAH

12 APOTEK PRIMA Jln. Cilik Riwut RT. 17 Selat Dalam Kapuas

13 APOTEK QOLBI Jln. Ahmad Yani Kapuas

Jln. Melati No. 11 RT. 27 RW. 03 Selat

14 APOTEK RAHMA Kapuas
Tengah, Selat
 APOTEK RAHNA INDRI
15 FARMA

16 APOTEK SEDERHANA Jln. Teratai No 144 Selat Tengah, Selat Kapuas

17 APOTEK SEJAHTERA Jln. Barito No 111 RT. 24, Selat Kapuas

18 APOTEK SELARAS Jln. Ahmad Yani Ruko No 2 Kapuas

19 APOTEK SHELA Jln. Melati No 45 Kapuas

20 APOTEK SIAGA Jln. Tambun Bungai Kapuas

21 APOTEK TANTOWI 99 Jln. Mawar No 45 Kapuas

22 APOTEK WARAS Jln. Mawar Komp. Pertokoan Kapuas

23 TDK PEGANG APOTEK

24 TDK PEGANG APOTEK

25 TDK PEGANG APOTEK

26 TDK PEGANG APOTEK

27 TDK PEGANG APOTEK

28 TDK PEGANG APOTEK

29 TDK PEGANG APOTEK

 IKATAN APOTEKER INDONESIA
PENGURUS CABANG KABUPATEN KAPUAS
PROPINSI KALIMANTAN TENGAH
Sekretariat : RSUD. Dr. H. SOEMARNO SOSROATMODJO
JL. TAMBUN BUNGAI NO. 16 TELP. 0513-21653 FAX. 0513-23791
KABUPATEN KAPUAS – KALIMANTAN TENGAH

DATA ANGGOTA IAI

No Izin Tanggal Izin Masa Berlaku Izin No Telp

503.B21/1/DPMPTSP- 21 Maret 2017 21 Maret 2022 0513-21653

03/2017
503.12/00010/KESRA- 02 Desember 02 Desember 2021 085229249879
BPPT/2016 2016
503.12/00005/KESRA- 15 Juli 2016 21-Sep-21 08195123444
BPPT/2016

503.12/00006/KESRA- 13-Nov-15 13-Nov-20 081350371957

BPPT/2015

503.12/00005/KESRA- 02 Oktober 02 Oktober 2019 0513-21712

BPPT/2014 2014
503.B13/006/DPMPTSP- 28 Desember 4-Apr-19
03/2018 2018
503.B13/001/DPMPTSP- 02 Februari 28 Oktober 2019 0513-2026265
03/2018 2018
503.12/00007/KESRA- 26-Sep-16 26-Sep-21 081348959979
BPPT/2016
503.B.13/3/DPMPTSP- 09 Juni 2017 09 Juni 2022 0513-24409
03/2017

503.B.13/DPMPTSP-03/3017 18 Juli 2017 18 Juli 2022 0513-6768618

503.12/00006/KESRA- 20 Oktober 20 Oktober 2019

BPPT/2014 2014
503.12/00001/KESRA- 085292910004
BPPT/2014

Dlm Proses Dlm Proses Dlm Proses 083155885872

 Dlm Proses Dlm Proses Dlm Proses

503.B.13/1/DPMPTSP- 30 Januari 2019 22-Apr-23 0513-21373

03/3019

503.B/002/DPMTSP-03/2018 27-Apr-18 17 Februari 2021 085651030421

503.12/00009/KESRA- 30 Desember 30 Desember 2021 085228290200

BPPT/2016 2016
503.12/00006/KESRA- 5-Sep-16 5-Sep-21 082153220607
BPPT/2016
503.12/00001/KESRA- 14 Maret 2016 14 Maret 2021 082134434193
BPPT/2016
503.B.13/4/DPMPTSP-
03/2017 16 Juni 2017 20 Juli 2020

503.B13/005/DPMPTSP- 31 Juli 2018 05 Oktober 2021 085350845549

03/2018
SIA
S

MODJO
0513-23791
H

Nama Pemilik
Sarana/Pimpinan Nama Penanggungjawab No SIPA
Sarana
503.7/00007/KESRA-
PEMDA KAPUAS EDEL SITORUS, M.Si., Apt BPPT/2016
503.7/00012/KESRA-
HUSIN MERY NORVISARY, S.Farm., Apt
BPPT/2016
RISKAN NOOR, S.Farm., RISKAN NOOR, S.Farm., Apt 503.7/00008/KESRA-
Apt BPPT/2016

H. MUHAJIRIN RESTU ASHA FAUZANA, S.Farm., Apt Dlm Proses

NORLIANA AGUSTINA, S.Farm., Apt

503.7/00015/KESRA-
H. NURULLAH BUDI RIBKA PALLANGAN, S.Si., Apt BPPT/2016
PT. KIMIA FARMA 503.B11/09/DPMPTS
ANDI ADI PURNA, S.Farm., Apt
APOTEK P-03/2018
503.B11/09/DPMPTS
H. MUHAMMAD RIFA'I SUCIATY ZAINUDDIN, M.Farm., Apt P-03/2017
503.B11/8/DPMPTSP-
MUHAMMAD FADLI HERNI MULIANI, S.Farm., Apt 3/2017
WIWIN INDRIASTUTI, 503.7/00016/KESRA-
WIWIN INDRIASTUTI, S.Farm., Apt
S.Farm., Apt BPPT/2016
HARIANTO, M.Pharm., MAHARANI RUKMANA PRAHESTI, S.Farm., 503.B11/5/DPMPTSP-
Apt Apt 3/2017
503.7/00002/KESRA-
H. IBERAHIM, MT IBNA RUSMANA, S.Far., Apt BPPT/2016
MAYA SCORVIYANTI, 503/00003/KESRA-
MAYA SCORVIYANTI, S.Farm., Apt
S.Farm., Apt BPPT/2014

Hj. SAUKIAH IWAN YUWINDRY, M.Farm., Apt Dlm Proses

 RAHNA INDRIANI, S.Farm., Apt Dlm Proses

HARIANTO, M.Pharm., HARIANTO, M.Pharm., Apt 503.B11/07/DPMPTS

Apt P-03/2018
ALDHIKA KURNIAWAN, AULIA AZIZAH, S.Farm., Apt 503.7/0003/KESRA-
ST BPPT/2016
SRI SUJANARTI 503.7/00011/KESRA-
AQUARINA, S.Farm., Apt
MURWANI BPPT/2016
SHELA PUZI DINA, 503.B11/08/DPMPTS
SHELA PUZI DINA, M.Farm., Apt
M.Farm., Apt P-3/2018
EKA PUJI LESTARI, 503.B11/7/DPMPTSP-
EKA PUJI LESTARI, S.Farm., Apt
S.Farm., Apt 3/2017
503.B11/4/DPMPTSP-
NOR A'IN ASITA, S.Farm., Apt 3/2017
503.B11/03/DPMPTS
SADIAH EKA PUJI ASTUTI, S.Far., Apt P-3/2018

SUZI MARTINA, S.Farm., Apt

RENNY FEBRIANTY, S.Farm., Apt

JOKO PRIYANTO WIBOWO, M.Si, Apt

MIATY ALMIRA, S.Farm., Apt

SYARIFAH MAULAYA, S.Farm., Apt

YUSRI KURNIA JAUHARI, S.Farm., Apt

RAHMI FAUZIAH, S.Farm., Apt