Background: Counterfeit medicines are a threat to public health and the national economy in Egypt. The many community pharmacists in the country could help prevent counterfeit medicines reaching the patient. Information on community pharmacists' perceptions of counterfeit medicines is lacking. Aims: This study assessed the awareness, practices and perceptions of community pharmacists in Alexandria, Egypt with regard to counterfeit medicines. The aim was to identify gaps and inadequacies in pharmacy practice that might allow infiltration of counterfeit medicines in the legitimate medicine supply chain. Methods: A cross-sectional study was conducted of 175 community pharmacists in Alexandria in 2014-2015. A semi-structured interview questionnaire was used to assess their perceptions, awareness and practices. The chi-squared test was used to assess the relationships between selected pharmacists' characteristics and their awareness, purchasing practice and training related to counterfeit medicines. Results: Most pharmacists thought medicine counterfeiting was widespread in Egypt and that they could contribute to combatting the problem. However, most also lacked a clear perception of counterfeit medicines, an awareness of their danger to patients or the legislation to reduce them. Their procurement practices and detection of counterfeit medicines and handling of incidents of counterfeit medicines were inadequate. Pharmacists who thought counterfeit medicines were widespread or a health threat were significantly more likely to purchase 1 / 12 WHO EMRO | Community pharmacists' perceptions, awareness and practices regarding counterfeit medi medicines from certified sources (P < 0.05). Conclusion: Pharmacists should be developed as a frontline resource to combat counterfeit medicines. To enhance their role, the pharmacy curriculum needs to be updated and continuing professional development activities mandated.