Objectives <p>To assess AI readiness, perceptions, and usage patterns among first-year pharmacy students, and to identify factors associated with AI engagement.</p> Methods <p>A mixed-methods study was conducted among 220 first-year pharmacy students. Quantitative data were collected using a structured questionnaire assessing AI readiness (cognition, ability, vision, ethics), perceptions, and usage, followed by multivariable regression analyses. Qualitative insights were obtained through semi-structured interviews with a purposive subsample and analyzed thematically.</p> Results <p>Students showed moderate overall AI readiness, with higher cognition and ability than vision and ethics. AI use was common, primarily for academic tasks, with ChatGPT as the most frequently used tool. Positive perceptions of AI in education predominated, alongside concerns about academic integrity and over-reliance. Higher digital literacy and urban residence were associated with greater AI readiness and more favorable perceptions. Qualitative findings revealed strong interest in structured, pharmacy-specific AI education emphasizing practical application and ethical guidance.</p> Conclusions <p>First-year pharmacy students demonstrate positive attitudes but uneven preparedness for AI. Early, structured integration of AI training that combines technical foundations with ethical and future-oriented perspectives is needed to support responsible AI adoption in pharmacy education.</p>