Background <p>Nigeria faces a dual burden of communicable and non-communicable diseases, placing considerable strain on the healthcare system. Pharmacists, as accessible healthcare providers, are well-positioned to promote health and prevent diseases; however, their potential remains underutilized. This study assessed pharmacists’ health promotion strategies, perceptions, and attitudes, identified predictors of perception and attitude, and examined challenges affecting implementation.</p> Methods <p>A descriptive cross-sectional survey was conducted among 383 community and hospital pharmacists across Nigeria between December 2024 and April 2025 using convenience and snowball sampling. A structured questionnaire assessed socio-demographics, health promotion strategies, perceptions, attitudes, and barriers. Perception and attitude scores were categorized based on median values. Data were analysed using SPSS v27. Descriptive statistics summarized responses, while the Fisher–Freeman–Halton exact test and multiple linear regression identified associations and predictors of pharmacists’ perceptions and attitudes toward health promotion.</p> Results <p>Overall, 351 (91.6%) pharmacists reported participation in health promotion activities, particularly interprofessional collaboration (345, 98.3%) and adherence counselling (343, 97.7%). Most pharmacists had positive perception (375, 97.9%) and attitude (371, 96.9%) toward health promotion. Key barriers included lack of training (234, 61.1%), inadequate consultation space (251, 65.5%), and limited patient time (271, 70.8%). Significant predictors of perception and attitude included age, gender, years of experience, additional qualifications, location of practice, and geopolitical zone. Specifically, younger pharmacists (21–30 years) had higher perception (B = 1.18, <i>p</i> = 0.046) but lower attitude (B = − 2.27, <i>p</i> &lt; 0.001) scores than those aged 31–40 years. Male pharmacists had lower perception scores than females (B = − 1.31, <i>p</i> = 0.010). Rural practitioners had lower perception (B = − 2.68, <i>p</i> &lt; 0.001) but higher attitude (B = 1.79, <i>p</i> = 0.014) scores than urban counterparts. Pharmacists in North Central (B = 5.36, <i>p</i> = 0.030) and South West zones (B = 4.99, <i>p</i> = 0.042) demonstrated higher perception scores compared with North West practitioners while area of practice was not significantly associated with perception (<i>p</i> = 0.458) or attitude (<i>p</i> = 0.763).</p> Conclusion <p>Pharmacists in Nigeria demonstrated positive perception and attitude toward health promotion but faced systemic and resource challenges. Professional experience, qualifications, and geopolitical location significantly influenced the pharmacists’ perception and attitude. Targeted training, policy support, and infrastructural investment are essential to enhance pharmacists’ contribution to preventive healthcare and public health.</p> Clinical trial number <p>Not applicable.</p>