BACKGROUND: The integration of artificial intelligence (AI) into pharmacy practice has the potential to advance learning experiences and prepare future pharmacists for evolving healthcare needs. However, it also raises ethical considerations that need to be addressed carefully. This study aimed to explore pharmacy students' attitudes regarding AI integration into their future pharmacy practice. METHODS: A cross-sectional design was employed, utilizing a validated online questionnaire administered to pharmacy students from diverse demographic backgrounds in multiple countries of the Middle East and North Africa (MENA) region from August 2022 to January 2023. Demographic, education, and work information data were, respectively, collected from study participants. In addition, technology literacy and AI familiarity were collected using a Likert scale on skill and a Likert scale on familiarity. Finally, participants' concerns and perceived barriers regarding AI integration were collected based on a Likert scale on agreement. RESULTS: A total of 702 pharmacy students participated in the study, with the majority being female (72.8 %), enrolled in public universities (55.6 %), and not employed (64.2 %). Participants expressed a generally negative attitude towards AI integration, where 56.2-70.8 % of respondents agreed/strongly agreed to concerns/barriers including patient data privacy (62.0 %), susceptibility to hacking (56.2 %), potential job displacement (69.3 %), cost limitations (66.8 %), access (69.1 %), the absence of regulations (68.1 %), and training (70.4 %), physicians' reluctance (65.1 %), and patient apprehension (70.8 %). Factors including country of residence, academic year, cumulative GPA, work status, technology literacy, and AI understanding influenced participants' attitudes. Positive correlations were found between attitude score and tech-savviness (r = 0.174), and AI understanding (r = 0.155). CONCLUSION: Pharmacy students from multiple countries in the MENA region express significant ethical and practical concerns about AI's integration into their future practice. These findings underscore the need for incorporating AI education within pharmacy curricula, alongside the development of robust ethical guidelines and regulatory policies. Addressing students' concerns is crucial to ensuring ethical, equitable, and beneficial AI integration in future pharmacy practice.