Background: Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used for pain, inflammation, and fever. Although many NSAIDs are available without a prescription, inappropriate use may increase the risk of renal, gastrointestinal, and cardiovascular complications. This study evaluated NSAID dispensing patterns and potential risk practices in community pharmacies in the Eastern Province of Saudi Arabia. Methods: A cross-sectional study was conducted in 90 community pharmacies across Al-Ahsa, Al-Dammam, and Jubail Industrial City between February and March 2025. Data on demographics, NSAID type, indication, dosage, frequency, duration, and concomitant medication use were collected and analyzed descriptively. Results: Among the 171 documented NSAID dispensing cases, 98 (57.3%) occurred without a prescription, whereas 73 (42.7%) involved prescription-based dispensing. Ibuprofen (62%) and diclofenac (36.3%) were the most commonly dispensed agents, with oral tablets being the preferred formulation (76.6%). Most documented treatment durations were short (3–7 days) with once- or twice-daily dosing. Common documented indications included dental conditions, pain, and inflammation, although the indication was not specified in 57.3% of cases. At least one potential interaction was identified in 11(7.8%, 95% CI 4.4–13.4%) of the 141 cases with concomitant medication use, corresponding to 13 (5.9%, 95% CI 3.5–9.9%) potential interaction pairs. Conclusions: Frequent non-prescription NSAID dispensing, incomplete documentation, and potentially clinically relevant drug interactions highlight the need to strengthen medication review, documentation, public awareness, regulatory oversight, and pharmacist counseling in community pharmacy practice.