OBJECTIVES: Consumers expect pharmacists to dispense medication accurately, efficiently, and conveniently. In this environment, opportunities exist to investigate how medication safety may be compromised when cognitive processes interfere with sociotechnical (interaction of the social and technological systems) variables to cause dispensing errors as perceived by pharmacists in community practice. METHODS: Attitudinal items relating to the sociotechnical aspects of pharmacy design, drive through window pick-up service, and automated dispensing system use were evaluated using a five-point Likert-type scale with respect to dispensing errors and communication, prescription processing, prescription volume, and physical mobility in the pharmacy. A response rate of 45% (n = 429) was obtained from a two-page survey that was mailed to a geographically stratified random sample of community pharmacies in the United States. RESULTS: Pharmacists attributed 80.3% of the perceived dispensing errors to cognition and 15.8% of the errors to pharmacy design. Significant differences (p <0.05) were observed for the sociotechnical variables related to pharmacy design, drive through window pick-up service, and automated dispensing system use. The perceived dispensing error rate averaged among the three pharmacy settings (mass merchant, chain, and independent pharmacies) was 0.057%, and the number of dispensing errors was positively and significantly (p <0.001) correlated with prescription volume. CONCLUSION: Perceptions of dispensing errors by pharmacists are influenced by pharmacy design, drive through pick-up window service, and automated dispensing system use. From a policy perspective, greater effort is needed to determine how cognitive processes relate to sociotechnical variables in this environment, and how standards for medication safety can be maintained and improved.