Blue Bridge Specialty Pharmacy, LLC

Primary specialty

Home Infusion Therapy PharmacyTaxonomy code 3336H0001X

Legal business name

BLUE BRIDGE SPECIALTY PHARMACY, LLC

Practice address

630 Kenmoor Ave SE Ste 102
Grand Rapids, MI 49546-8626

Phone

(616) 280-4211

Fax

(616) 280-4214

NPI assigned

Jul 16, 2025

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Max Bloomquist

Title

Owner

Phone

(616) 280-4211

Specialties & licenses 6

Addresses

Other names 1

• Vital Care of Grand Rapids Doing business as

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1752624000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752796800000",
    "number": "1225920168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "630 KENMOOR AVE SE STE 102",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495468626",
            "telephone_number": "616-280-4211",
            "fax_number": "616-280-4214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 KENMOOR AVE SE STE 102",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495468626",
            "telephone_number": "616-280-4211",
            "fax_number": "616-280-4214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE BRIDGE SPECIALTY PHARMACY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-07-16",
        "last_updated": "2025-07-18",
        "certification_date": "2025-07-18",
        "status": "A",
        "authorized_official_last_name": "BLOOMQUIST",
        "authorized_official_first_name": "MAX",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "616-280-4211"
    },
    "taxonomies": [
        {
            "code": "251F00000X",
            "taxonomy_group": "",
            "desc": "Home Infusion",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336H0001X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Home Infusion Therapy Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vital Care of Grand Rapids",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Julie C Blossom-Hartley, MD
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• Shannon Marie Blourne
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• Brandon Blue
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• Home Infusion Therapy Pharmacy in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Home Infusion Therapy Pharmacy in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.