<p>Pharmaceutical calculations are a core competency in pharmacy education and are essential for patient safety and effective clinical care. In the context of pharmacy education, diverse delivery and assessment strategies exist, and there are ongoing modifications to the pharmacy education landscape. This study explored the perceptions, confidence levels, and educational experiences of senior PharmD students regarding their pharmaceutical calculation skills and perceived preparedness for clinical practice. A qualitatively driven mixed-methods design was employed. A structured, anonymous survey comprising Likert-scale and open-ended questions was distributed to all fifth-year PharmD students at KSU (N = 141). A total of 141 complete responses were analyzed using descriptive statistics, the Chi-square test, and the Mann–Whitney U test for quantitative data, as well as thematic analysis for qualitative responses. The results revealed that most students (76.9%) reported positive experience with pharmaceutical calculations, and 79% indicated that extra academic support was available. The mode confidence rating was 5 (very confident), with a median of 4, suggesting a generally high self-reported perceived confidence. No statistically significant gender differences were observed in terms of confidence or experience. Students predominantly relied on digital tools (e.g., ChatGPT, YouTube, Excel) rather than traditional academic resources, and the majority expressed a desire for more real-world applications and practice-based learning. In summary, while students reported high perceived confidence in their pharmaceutical calculation abilities, many expressed uncertainties about their real-world relevance. These findings highlight the importance of practice-based, context-driven instruction, and the thoughtful integration of digital learning tools to enhance students' perceived relevance and engagement with pharmaceutical calculations.</p>