Background: The geographic distribution of pharmacies reflects interactions between population needs, economic viability, professional regulation, and healthcare development. Historical analysis can clarify how territorial inequalities in pharmaceutical provision emerged. Methods: This retrospective historical study reconstructed the pharmacy network in Bihor before 1920 using archival records, contemporary pharmaceutical yearbooks, historical statistics, and published studies. Oradea was analysed separately from the extra-urban county territory. Independent establishments were distinguished from relocations and dependent units, and temporal, geographic, and population-to-pharmacy indicators were calculated and interpreted descriptively. Results: Outside Oradea, 31 historical pharmacy entries were identified between 1798 and 1915; 28 were independent establishments, two were relocations, and one was a dependent branch. Nineteen of the 28 independent establishments (67.9%) appeared after 1880, and 23 (82.1%) represented first pharmacies in previously unserved localities. By the end of the analysed period, pharmacy provision remained markedly more concentrated in Oradea than in the extra-urban territory. Conclusions: Pharmacy development in Bihor followed a centre–periphery pattern characterised by early urban concentration, delayed territorial diffusion, and selective local intensification, illustrating a lasting tension between economic viability and equitable geographical access to pharmacy services. The findings show that the numerical expansion of a pharmacy network does not by itself ensure equitable access, a challenge that remains relevant to contemporary pharmacy regulation and practice.